Journal of Orthodontics最新文献

Objective: To investigate young people's experience of retainer wear in the immediate term and at 6 months after appliance removal, and to explore the factors affecting retainer wear adherence.

Design: Qualitative study.

Setting: Orthodontic departments at two teaching hospitals in Yorkshire, UK.

Participants: A total of 12 participants aged 13-18 years were recruited using a purposive sampling approach.

Methods: Data collection occurred through one-to-one, virtual, photo-elicitation interviews at two time points (immediate and 6 months) with data analysed using interpretative phenomenological analysis (IPA).

Results: Three overarching themes were developed to describe young people's experience of orthodontic retention: immediate experience and expectation of retainers; the process of adaptation; and motivating factors. Barriers to adherence were mostly ascribed to daytime wear, despite normalisation of retainers in young people's lives. Interventions to help individuals overcome the initial adaptation phase and self-manage their foreseen problems of forgetfulness include routines and reminders, which seem to be less important at 6 months. At both time points, internal and external motivation significantly contribute to retainer adherence, with compensatory changes in behaviour being more important at 6 months.

Conclusions: Understanding early experiences of retainer wear can help clinicians to provide timely and well-targeted interventions and information. Co-constructing unique adherence strategies may help to overcome the initial adaptation phase, with particular emphasis on understanding the individual.

In recent years, a segmental approach to Class II correction has gained popularity among orthodontists. This concept is best represented by the Carrière Motion 3D™ Class II Appliance (CMA), which is an efficient and effective appliance for the treatment of Class II malocclusions. Although it is original and innovative, it also has some inherent flaws that can potentially interfere with its daily use. A segmental approach is described, based on a section of 0.016 × 0.022-inch stainless steel archwire connected to a molar band distally and to a bracket on the mesial side. This simple alternative presents a 'do-it-yourself' and an easy-to-construct mechanism that employs the same principles and identical mechanics to achieve Class II correction yet overcomes most of the disadvantages of other modalities. In our clinic, we found that this optional, useful sectional appliance can correct Class II malocclusion effectively, predictively and on a regular basis.

Aim: To compare microleakage beneath ceramic and metal brackets prepared with either acid etching or laser conditioning.

Design: An in vitro study.

Setting: Department of Orthodontics, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt.

Methods: A total of 40 intact human premolars were selected and divided into four equal groups. The groups received the same adhesive-application procedures with different surface treatments and type of brackets: groups 1 (AM) and 3 (AC) underwent phosphoric acid etching; groups 2 (LM) and 4 (LC) underwent laser enamel conditioning using a Er,Cr:YSGG laser. Metal brackets were then bonded to the teeth in groups 1 (AM) and 2 (LM) and ceramic brackets in groups 3 (AC) and 4 (LC). Subsequently, they were placed in fuchsin dye solution. Each premolar was sectioned longitudinally in the occluso-gingival direction at right angles to the brackets. The dye penetration depth was calculated using a stereomicroscope. Microleakage was measured along the enamel-adhesive interface at each section's gingival and occlusal levels. For group comparisons, the Tukey test was utilised as a post hoc test to determine statistical significance between groups. The independent sample t-test was utilised for comparing both subgroups.

Results: The results demonstrated significantly more microleakage under metal and ceramic brackets bonded to enamel prepared with laser conditioning than with acid etching at both the gingival and occlusal surfaces and in total. The AC group exhibited the lowest amount of microleakage, but the LC group demonstrated the highest amount of microleakage.

Conclusion: The ceramic bracket group treated with acid etching exhibited the lowest level of microleakage. Microleakage values on the gingival and occlusal surfaces were higher in both bracket types for the laser etched groups.

Objective: To assess the type, number and outcome of remote appointments in Orthodontics and Oral and Maxillofacial Surgery (OMFS) in one acute hospital trust and to establish whether remote appointments carried out during the Covid-19 pandemic were successful in saving a face-to-face appointment.

Design: Service evaluation.

Setting: Orthodontic and OMFS departments at Buckinghamshire Healthcare NHS Trust.

Method: A retrospective service evaluation was carried out, analysing the types, numbers and outcomes of remote appointments in Orthodontics and OMFS over a nine-month period (March-December 2020) during the Covid-19 pandemic in one hospital trust. Data were collected from the trust online booking system and departmental spreadsheets and recorded on Microsoft^® Excel.

Results: A total of 901 remote appointments were analysed, 42% (n = 387) of which were Orthodontic and 58% (n = 523) OMFS. Low failure to attend rates were seen in both specialties (3% (n = 18) OMFS; 6% (n = 21) Orthodontics). Retainer reviews accounted for 83% (n = 315) of all Orthodontic remote appointments and the most common outcome of remote appointments was discharge after attendance (49% n = 189). New patient consultations accounted for 41% (n = 212) of OMFS remote appointments and the most common outcomes were Oral Medicine review (31% n = 162) and discharge following attendance (20% n = 103). Remote platforms saved a follow-up face-to-face appointment in 92% (n = 352) of Orthodontic appointments, compared to 81% (n = 421) for OMFS remote appointments.

Conclusion: When appropriately triaged, the majority of remote appointments do save a face-to-face visit, and there is a place for remote platforms in both specialties going forward. However further research is required in the post-pandemic era to ascertain the full long-term applicability of remote Orthodontic and OMFS appointments.

Objectives: To assess clinician perceptions of and satisfaction with remote appointments in orthodontics and oral and maxillofacial surgery (OMFS).

Design: Cross-sectional questionnaire-based study.

Setting: Orthodontic and OMFS departments in six acute NHS hospital Trusts in the UK.

Participants: A total of 36 (a mixture of consultants, specialty doctors, registrars and therapists in both orthodontics and OMFS) completed responses were received.

Method: Once piloted, questionnaires were disseminated across six hospital Trusts to orthodontic and OMFS clinicians. A combination of face-to-face (F2F) and online dissemination was used.

Results: A total of 28 of 36 (77.8%) questionnaires were completed, 75% (n = 21) by orthodontic clinicians and 25% (n = 7) by OMFS clinicians. A 100% (n = 21) response rate was achieved for orthodontic clinicians, compared to a 47% (n = 7/15) response rate for OMFS clinicians. High levels of clinician satisfaction were found for clinician confidentiality; however, concerns remained around patient confidentiality and the inability to conduct a clinical examination. The majority (n = 21, 75%) of clinicians felt that remote appointments had their place in the post-pandemic era, particularly for retainer reviews in orthodontics and biopsy results in OMFS.

Conclusion: When appropriately triaged, the majority of remote appointments do save a face-to-face visit, and there is a place for remote platforms in both specialties going forward. However further research is required in the post-pandemic era to ascertain the full long-term applicability of remote orthodontic and OMFS consultations.

Aim: To evaluate the effect of chewing gum on the rate of space closure, oral hygiene, pain during space closure and appliance breakage in patients undergoing fixed appliance therapy.

Design: A prospective, single-centre, two-arm, parallel, double-blinded randomised controlled trial.

Setting: Orthodontic unit of a privately funded hospital, Chennai, India.

Participants: In total, 28 participants were randomly allocated into a chewing gum group (CGG) (n = 14) or a control group (CG) (n = 14).

Methods: Baseline data were collected at the start of retraction (T0), at 4 weeks (T1), 8 weeks (T2) and 12 weeks (T3) after the start of retraction. Rate of space closure, pain, oral hygiene and appliance breakage were assessed at T1, T2 and T3. Data were analysed using an independent t-test with P < 0.05 considered to be statistically significant.

Results: The mean rate of space closure in the CGG was 0.9 ± 0.2 mm/month and 0.8 ± 0.2 mm/month in the CG (mean difference 0.1mm/month ± 0.16; 95% confidence interval -0.055-0.26). In both the groups, oral hygiene became worse between T0 and T3. At T0 and T1, participants in the CGG reported less pain at 24 h and 7 days when compared to the CG (P < 0.05). At T2 and T3, participants in the CGG reported less pain at 0 h, 24 h and 7 days when compared to the CG (P < 0.05). Appliance breakage in both groups was minimal, with an odds ratio of 0.7 (95% CI 0.1-3.8) and was similar (P = 0.66).

Conclusion: There was a minimal increase that was clinically not significant in the rate of space closure with chewing gum. Chewing gum ensured better oral hygiene, helped alleviate pain and had no effect on appliance breakage during space closure.

Objective: To assess changes in clinical crown height (CCH) in adult orthodontic patients treated by fixed appliances to distalise the molars.

Design: Retrospective case series study.

Setting and patients: A total of 30 adults with healthy periodontal tissues who received orthodontic treatment at the Department of Orthodontics, Yokohama, Japan and its related orthodontic clinic were assessed.

Methods: CCH was measured as the distance from the gingival margin to the crown plane perpendicular to the tooth axis. Treatment changes of CCH of each tooth were examined on the labial/buccal and lingual/palatal side.

Results: In the upper dentition, on the labial/buccal side, the CCH of the lateral incisors, canines, first premolars, first molars and second molars were increased significantly (P < 0.01), with a median value of 0.41 mm, 0.43 mm, 0.28 mm, 0.43 mm and 0.55 mm, respectively. In contrast on the palatal side, the CCH of the central incisors, first molars, and second molars decreased significantly (P < 0.01), with a median value of -0.41 mm, -0.30 mm and -0.20 mm, respectively. In the lower dentition on the labial/buccal side, the CCH of the first premolars, second premolars and first molars were increased significantly, with a median value of 0.39 mm (P < 0.01), 0.43 mm (P < 0.01) and 0.19 mm (P < 0.05), respectively. The second molars exhibited a significant decrease in CCH with a median value of -0.26 mm (P < 0.05). On the lingual side, the CCH of the central incisors, lateral incisors, canines, first premolars, second premolars and first molars were increased significantly (P < 0.01), with a median value of 0.28 mm, 0.22 mm, 0.31 mm, 0.37 mm, 0.26 mm and 0.28 mm, respectively.

Conclusion: Significant differences were observed in CCH before and after treatment for many teeth, the average change was less than 0.5 mm. The impact on the long-term health of the periodontal tissue is unknown.

Objective: To evaluate the difference in the oral hygiene status of participants with fixed appliances between a 'weekly WhatsApp application oral hygiene message reminders' trial group and a 'verbal instructions' control group over a follow-up duration of 12 weeks.

Design: Prospective, single-blind, randomised controlled trial with an allocation ratio of 1:1 over a 12-week follow-up.

Setting: Government Orthodontic Unit, Raub Dental Clinic, Raub, Pahang, Ministry of Health, Malaysia.

Participants: A total of 40 patients aged 13-25 years undergoing orthodontic treatment with fixed appliances.

Methods: The 40 patients were recruited and randomly allocated to a control (n = 20) or trial group (n = 20). Participants in the trial group received weekly oral hygiene reminders via the WhatsApp application for 12 weeks, while the control group did not receive any reminders. The primary outcome was oral hygiene, which was measured by the single-blinded examiner using the Orthodontic Plaque Index (OPI) at three orthodontic check-ups: baseline (T0); 6-week follow-up (T1); and 12-week follow-up (T2).

Results: The mean age of participants was 17 years, and 80% were female. At the end of the 12-week follow-up, improvements in OPI scores were observed, regardless of the intervention. At T2, the median OPI score for the trial group (n = 20) was 0 (interquartile range [IQR = 0) while that for the control group (n = 20) was 2 (IQR = 0). A Mann-Whitney U test revealed a statistically significant difference (P <0.05), with effect size r = 0.87 between the control and trial groups, whereby the latter witnessed marked improvement in OPI throughout the visits. No harms or adverse effects occurred in this trial.

Conclusion: The short-term findings demonstrated that participants receiving regular reminders of oral hygiene via WhatsApp messaging had a significant improvement in oral hygiene compared to the control group.