OBJECTIVE: To establish whether the use of a WaterPik alongside a manual toothbrush (WaterPik + MTB) is more effective for maintaining oral hygiene compared to the use of a manual toothbrush alone (MTB) in patients weari...OBJECTIVE: To establish whether the use of a WaterPik alongside a manual toothbrush (WaterPik + MTB) is more effective for maintaining oral hygiene compared to the use of a manual toothbrush alone (MTB) in patients wearing fixed orthodontic appliances. DESIGN: A single-centre, two-arm, parallel-group, single-blind, randomised controlled clinical trial with a 1:1 allocation ratio. SETTING: Orthodontic department at York Hospital, York Teaching Hospitals NHS Foundation Trust, UK. PARTICIPANTS: A total of 40 fit and well participants, aged 10-20 years, being treated with upper and lower fixed orthodontic appliances. METHODS: Participants were randomly allocated, using stratified block randomisation, to the control group (MTB) or intervention group '(Waterpik + MTB)'. Plaque, gingival and interdental bleeding indices were recorded at baseline, 8 weeks, 32 weeks and 56 weeks. A generalised linear mixed model was used to assess differences between groups. RESULTS: An interim analysis of results was performed with 40 patients recruited and 85% of data collected. The overall mean differences between the groups were as follows: plaque index = 0.199 ( = 0.88, 95% confidence interval [CI] -0.24 to 0.27); gingival index = -0.008 ( = 0.94, 95% CI -0.22 to 0.20); and interdental bleeding index = 5.60 ( = 0.563, 95% CI -13.22 to 24.42). No statistical difference between the two groups was found for any variable. The trial was stopped at this point. CONCLUSIONS: In terms of oral hygiene, our study did not find evidence to support the claim of benefit of using a Waterpik in addition to a manual toothbrush for patients wearing fixed orthodontic appliances.
OBJECTIVE: To highlight the potential environmental impact of different aspects of orthodontic care in the United Kingdom, outline the major barriers and challenges to reducing this impact, and summarise the possible act...OBJECTIVE: To highlight the potential environmental impact of different aspects of orthodontic care in the United Kingdom, outline the major barriers and challenges to reducing this impact, and summarise the possible action that could help the orthodontic community to tackle the climate change crisis. IMPACT: Travel, procurement and supply, material use, waste management, energy use and water consumption within dentistry have a considerable effect on the environment. There are, however, marked knowledge gaps pertaining to the impact of orthodontic treatment. CHALLENGES: The lack of awareness of the NHS contribution to the carbon footprint and net-zero goals among healthcare workers, the NHS backlogs and budget cuts, and cross-infection control requirements particularly following the COVID-19 pandemic are some of the many challenges to making healthcare delivery more sustainable. OPPORTUNITIES: By considering the triple bottom line (social, environmental and economic), incorporating the four Rs (Reduce, Reuse, Recycle, Rethink), taking practical action, including steps to educate ourselves and the wider team, and to promote research on environmental sustainability, we can get one step closer to reaching the NHS net-zero goals. CONCLUSION: Climate change is a global health threat with multiple contributors associated with orthodontic treatment delivery, which can be tackled on an individual, organisational and system level.
INTRODUCTION: Artificial intelligence (AI) technology has transformed the way healthcare functions in the present scenario. In orthodontics, expert systems and machine learning have aided clinicians in making complex, mu...INTRODUCTION: Artificial intelligence (AI) technology has transformed the way healthcare functions in the present scenario. In orthodontics, expert systems and machine learning have aided clinicians in making complex, multifactorial decisions. One such scenario is an extraction decision in a borderline case. OBJECTIVE: The present in silico study was planned with the intention of building an AI model for extraction decisions in borderline orthodontic cases. DESIGN: An observational analytical study. SETTING: Department of Orthodontics, Hitkarini Dental College and Hospital, Madhya Pradesh Medical University, Jabalpur, India. METHODS: An artificial neural network (ANN) model for extraction or non-extraction decisions in borderline orthodontic cases was constructed based on a supervised learning algorithm using the Python (version 3.9) Sci-Kit Learn library and feed-forward backpropagation method. Based on 40 borderline orthodontic cases, 20 experienced clinicians were asked to recommend extraction or non-extraction treatment. The decision of the orthodontist and the diagnostic records, including the selected extraoral and intra-oral features, model analysis and cephalometric analysis parameters, constituted the training dataset of AI. The built-in model was then tested using a testing dataset of 20 borderline cases. After running the model on the testing dataset, the accuracy, F1 score, precision and recall were calculated. RESULTS: The present AI model showed an accuracy of 97.97% for extraction and non-extraction decision-making. The receiver operating curve (ROC) and cumulative accuracy profile showed a near-perfect model with precision, recall and F1 values of 0.80, 0.84 and 0.82 for non-extraction decisions and 0.90, 0.87 and 0.88 for extraction decisions. LIMITATION: As the present study was preliminary in nature, the dataset included was too small and population-specific. CONCLUSION: The present AI model gave accurate results in decision-making capabilities related to extraction and non-extraction treatment modalities in borderline orthodontic cases of the present population.
INTRODUCTION: Orthodontic discrepancies are a common finding in patients with supernumerary teeth (ST). The presence of a ST can cause a number of orthodontic discrepancies, including delayed eruption or retention of adj...INTRODUCTION: Orthodontic discrepancies are a common finding in patients with supernumerary teeth (ST). The presence of a ST can cause a number of orthodontic discrepancies, including delayed eruption or retention of adjacent teeth, crowding, spacing, and abnormal root formation. The aim of the present study was to assess the effect of extraction of an anterior supernumerary tooth on the underlying orthodontic discrepancies without additional treatment for a 6-month period. METHODS: This was a prospective, longitudinal, observational, study. It included 40 participants with orthodontic malocclusions due to maxillary anterior supernumeraries. We examined the changes in the crowding and excessive space in the anterior and posterior segments on cast models. RESULTS: In the group that presented with crowding, a statistically significant decrease of 0.95 ± 0.17 mm ( < 0.001) was found between T0 and T1. Of the participants, three exhibited full self-correction. The excessive space at T0 (3.06 mm) decreased by 1.78 ± 0.19 mm to T1 (1.28 mm) in the anterior segment. Seven participants showed full self-correction of the diastemas after the 6-month observation period. CONCLUSION: The results imply that orthodontic treatment can be postponed for at least 6 months after the extraction of the supernumerary tooth as potential self-correction can be expected. This natural alleviation of the malocclusions may make the orthodontic treatment simpler, shorten the treatment time and decrease overall appliance wear time.
A 16-year-old female patient presented to the orthodontic department with a 2-week history of painful oral lesions that were affecting her ability to eat. Clinical examination revealed widespread oral ulceration, crusted...A 16-year-old female patient presented to the orthodontic department with a 2-week history of painful oral lesions that were affecting her ability to eat. Clinical examination revealed widespread oral ulceration, crusted bleeding from the lips with evidence of a herpes simplex infection in the region of the right buccal commissure. A diagnosis of oral erythema multiforme (EM) was made after a detailed clinical history and examination by the oral and maxillofacial team. Supportive care was provided alongside management with topical corticosteroids. Within 6 weeks of initial presentation, complete resolution of the lesions had occurred and the patient was able to resume active orthodontic treatment.
INTRODUCTION: This survey was undertaken as a second part to 'Barriers to Post-CCST training in orthodontics: A survey of trainee perceptions'. Recruitment of Post-CCST trainees in certain areas of the country has attrac...INTRODUCTION: This survey was undertaken as a second part to 'Barriers to Post-CCST training in orthodontics: A survey of trainee perceptions'. Recruitment of Post-CCST trainees in certain areas of the country has attracted concerns as it has become increasingly difficult. This survey was undertaken to assess trainee satisfaction with Post-CCST training and to look at possible ways to improve trainee satisfaction and make Post-CCST training more desirable. METHODS: The Training Grades Group (TGG) committee of the British Orthodontic Society (BOS) produced an online survey that was sent to all TGG members and newly qualified consultants in May 2021. All Post-CCSTs who entered training between February 2017 and October 2020, were asked to complete the survey. RESULTS: There were 37 respondents, which gave a response rate of 62%. While 61% of respondents were satisfied with their Post-CCST training, 17% were 'neither satisfied or dissatisfied' and 6% were either 'dissatisfied' or 'very dissatisfied'. Of the 37 respondents, 25 (67%) would apply for Post-CCST training again, 6 (16%) would not and 6 (16%) did not answer this question. When asked for possible suggestions for improvements to Post-CCST training to encourage greater satisfaction, the responses could be grouped into the following themes: Part-time training; Teaching; Time commitment; Salary; and Experience. CONCLUSION: In general, respondents were satisfied with Post-CCST training. There was a significant range of positive and negative responses to various aspects of training including multidisciplinary team clinic preparation, support, supervision and management experience. Suggestions for improvements echo the barriers to Post-CCST training survey.
The aetiology of impacted canines is multi-factorial. Several theories have been proposed, such as lack of space, genetic predisposition, physical barriers like supernumerary teeth, odontomas and other conditions that in...The aetiology of impacted canines is multi-factorial. Several theories have been proposed, such as lack of space, genetic predisposition, physical barriers like supernumerary teeth, odontomas and other conditions that interfere with the eruption pathway. One of the main complications that can be generated by impacted canines is the resorption of the root of the adjacent teeth. This case report examines the importance of interdisciplinary management of maxillary incisors with root resorption caused by impacted canines in a 13-year-old male patient. Careful traction of impacted canines and proper tissue management followed by space closure and retroclination of anterior incisors with orthodontic treatment. Finally, functional and aesthetic results using dental veneers for oral rehabilitation allowed the patient to obtain favourable results.
OBJECTIVE: To compare two methods of maxillary molar distalisation with skeletal anchorage using finite element analysis (FEA). METHODS: Two digitised models were created: the miniscrew-anchored distaliser, which consist...OBJECTIVE: To compare two methods of maxillary molar distalisation with skeletal anchorage using finite element analysis (FEA). METHODS: Two digitised models were created: the miniscrew-anchored distaliser, which consisted of a distalisation method anchored in a buccal miniscrew between the first molar and second premolar (Model 1), and the miniscrew-anchored palatal appliance, which consisted of a distalisation method anchored in a miniscrew on the anterior region of the palate (Model 2). FEA was used to simulate both methods, assessing teeth displacements and stress concentration. RESULTS: The miniscrew-anchored distaliser showed greater buccal than distal displacement of the first molar, while the opposite was observed in the miniscrew-anchored palatal appliance. The second molar responded similarly in the transverse and anteroposterior perspectives with both appliances. Greater displacements were observed at crown level than in apical regions. Greater stress concentration was observed at the buccal and cervical regions of the crown in the miniscrew-anchored distaliser and the palatal and cervical regions in the palatal appliance. The stress progressively spread in the buccal side of the alveolar bone for the miniscrew-anchored distaliser and in the palatal root and alveolar bone for the palatal appliance. CONCLUSION: FEA assumes that both appliances would promote maxillary molar distalisation. A skeletally anchored palatal distalisation force seems to provide a greater molar bodily movement with less undesirable effects. Greater stress is expected at the crown and cervical regions during distalisation, and the stress concentration in the roots and alveolar bone depends directly on the region the force was applied.
We present a case report of early Le Fort I osteotomy with maxillary advancement retained postoperatively by Class III elastics anchored on miniplates in a growing patient with complete unilateral cleft lip and palate (U...We present a case report of early Le Fort I osteotomy with maxillary advancement retained postoperatively by Class III elastics anchored on miniplates in a growing patient with complete unilateral cleft lip and palate (UCLP). A 14-year-old boy who underwent orthognathic surgery at the pubertal growth spurt was presented. During surgery, Bollard miniplates were installed in the posterior region of the maxilla and in the anterior region of the mandible. Class III elastics anchored on miniplates were used at night (8-10 h) starting 60 days after surgery. The force of the elastics progressively increased from 100 g to 250 g. The elastics were replaced daily. The positive overjet remained stable over 15 months of postoperative follow-up. Maxillary advancement was adequately retained using Bollard miniplates and the facial profile remained stable until the end of facial growth.
OBJECTIVE: To explore the experiences of young people and their parents regarding the impact on school performance due to time away from school for orthodontic appointments and to explore their views about a possible ext...OBJECTIVE: To explore the experiences of young people and their parents regarding the impact on school performance due to time away from school for orthodontic appointments and to explore their views about a possible extension to the current service. DESIGN: A qualitative study using semi-structured interviews. SETTING: UK district hospitals. PARTICIPANTS: A total of 11 pairs of interviewees: young people undergoing fixed appliances and their parents. METHODS: Semi-structured interviews were conducted with young people and their parents. The interviews were audio recorded and transcribed verbatim. A framework approach was used to analyse the data. RESULTS: A thematic analysis of the data identified five main themes which were as follows: (1) expectations of the treatment process and appointments; (2) impact of school absences and treatment; (3) appointments; (4) implications for young people, parents and others; and (5) satisfaction with treatment. These themes were then further subdivided and analysed. CONCLUSION: Young people and their parents felt that attending appointments for orthodontic treatment had minimal impact on a young person's school performance. However, some young people did engage in coping mechanisms in order to ensure this was the case. Young people and their parents advised they were satisfied with the process of the treatment despite the time missed at school/work. Some young people and their parents saw a real benefit to appointments that could be fitted into a 'NHS seven-day' service model, but this did not apply to all interviewees.
OBJECTIVE: To investigate the total number of digital treatment plan (DTPs) and aligners manufactured for clear aligner therapy (CAT) by Invisalign from initial treatment planning to the completion of CAT. DESIGN: A retr...OBJECTIVE: To investigate the total number of digital treatment plan (DTPs) and aligners manufactured for clear aligner therapy (CAT) by Invisalign from initial treatment planning to the completion of CAT. DESIGN: A retrospective cohort study. MATERIAL AND METHODS: A total of 30 patients, from each of 11 experienced orthodontists, who commenced treatment over a 12-month period, were assessed regarding the number of DTPs and aligners prescribed from initial planning to completion of CAT. Patients were categorised according to the number of aligners prescribed by the initial DTP into mild (<15), moderate (15-29) or severe (>29). RESULTS: After the application of inclusion/exclusion criteria, 324 patients (71.9% women; median age = 28.5 years) undergoing non-extraction treatment with the Invisalign appliance were assessed. The median number of initial DTPs was 3 (interquartile range [IQR] = 2, 1-9) per patient before acceptance by the orthodontist. Most (99.4%) patients required a refinement phase with a median of 2 (IQR = 2, 2-7) refinement plans recorded. A total of 9135 aligners per dental arch, was prescribed in the initial DTP of the 324 patients assessed and 8452 in the refinement phase. The median number of aligners per dental arch prescribed from the initial DTP was 26 (IQR = 12, 6-78) and from the refinement plans was 20.5 (IQR = 17, 0-132). CONCLUSION: A median of three initial DTPs and two refinement plans were required for patients undergoing non-extraction treatment with the Invisalign appliance. Patients were prescribed almost double the number of aligners initially predicted to manage their malocclusion.
OBJECTIVE: The aim of the study was to explore the orthodontist's perspective of the strengths and weaknesses of their current multidisciplinary team (MDT) design for orthognathic treatment. PARTICIPANTS AND METHODS: Thi...OBJECTIVE: The aim of the study was to explore the orthodontist's perspective of the strengths and weaknesses of their current multidisciplinary team (MDT) design for orthognathic treatment. PARTICIPANTS AND METHODS: This was a qualitative study using online interviews of orthodontic consultants across England. The data were analysed using thematic analysis. This was the second part of a two-part study, where the first part, an online questionnaire survey, identified the variation in design of orthognathic MDTs across England and was the source of the 19 participants for this study. RESULTS: Seven themes were identified that influenced the design of orthognathic MDTs across England. Close working relationship with the team, access to closed surgery space to conduct the MDT and access to 3D planning were identified as definite strengths of some MDT clinics. Lack of a team psychologist and long waiting lists were identified as weaknesses of some orthognathic MDTs. Teaching and training within MDT clinics were highlighted as a strength of MDTs where surgery spaces were not restricted due to the pandemic. Finally, there was general agreement about revising the orthognathic minimum dataset for records collection as it was not thought to be in the patient's best interest. CONCLUSION: This study was able to identify key areas considered to be determinants of a successful orthognathic MDT design from the orthodontic consultant's perspective. Orthodontic consultants across England prioritised the need for a psychologist in the orthognathic MDT to improve the effectiveness of these clinics.
The placement of bonded retainers can be daunting to the inexperienced clinician. The aim of the present article was to share a simple means of using everyday intermaxillay elastics to effortlessly secure the wire, allow...The placement of bonded retainers can be daunting to the inexperienced clinician. The aim of the present article was to share a simple means of using everyday intermaxillay elastics to effortlessly secure the wire, allowing the clinician to easily complete placement of the bonded retainer. The challenge of manipulating the wire, etch, bond and composite simultaneously is thus alleviated! A step-by-step explanation is provided.
AIM: The aim of the present study was to undertake a systematic review of the available evidence on the release of bisphenol-A (BPA) from thermoplastic materials used in the fabrication of clear aligners (CA). METHODS: E...AIM: The aim of the present study was to undertake a systematic review of the available evidence on the release of bisphenol-A (BPA) from thermoplastic materials used in the fabrication of clear aligners (CA). METHODS: Electronic databases, such as MEDLINE (via PubMed), Google Scholar, Scopus, Cochrane Library, Web of Science, OpenGrey, and the U.S. National Institute of Heath-Clinical Trials, were searched up to 27 October 2022. In vivo/in vitro studies that assessed the release of BPA from different thermoplastic CA materials, with or without a control group, were selected. The risk of bias (RoB) in the randomised controlled trials (RCT) and in vitro studies was assessed using the Cochrane RoB tool and the guidelines for the reporting of pre-clinical studies, respectively. The quality of evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Pro tool. RESULTS: Six studies were considered for review from a total of 1926 records. This included one RCT and five in vitro studies. Only two studies found leaching of BPA, while four did not report any traces. The RoB was found to be moderate to high. The GRADE evidence level ranged from low to very low. Five of the included studies were conducted in vitro. Significant heterogeneity among the included studies prevented a quantitative synthesis. CONCLUSION: In light of the available conflicting evidence, BPA release from CAs can neither be confirmed nor denied. Safety remains questionable until high-quality in vivo trials prove otherwise. REGISTRATION: PROSPERO CRD42022310434.