Journal of Orthodontics最新文献

Objective: To ascertain the perceptions of the Welsh NHS orthodontic workforce regarding their job satisfaction and work life balance.

Design: Descriptive cross-sectional survey.

Participants and setting: Clinicians providing NHS orthodontic treatment in Wales.

Methods: An anonymised, email-distributed, electronic, two-part survey (onlinesurveys.ac.uk) of the Welsh NHS orthodontic workforce working within Wales was undertaken. The survey consisted of three sections: (1) demographic information (part 1); (2) respondents' working pattern (part 1); and (3) perceptions of professional job satisfaction and work/life balance (part 2). The responses received were exported into an Excel spreadsheet for descriptive analysis. The free-text comments were collated for each question and subsequently underwent a content analysis to identify any common themes.

Results: Part 2 of the survey yielded an overall response rate of 69.6% (n = 78). Over 96% (n = 75) of respondents felt that they had 'made the right career choice, including 100% of orthodontic trainees, orthodontic specialists and orthodontic consultants. Of the respondents, 88.5% (n = 69) said they 'enjoyed going to work', with the remaining being mostly neutral in their opinion. Of the respondents, 79.5% (n = 62) felt they were able to 'provide their patients the optimum care' and 64.1% (n = 50) felt that more demands were being placed upon them by patients and parents. Overall, 52.6% (n = 41) of survey respondents believed it was becoming increasingly difficult to achieve an effective work/life balance, and this was more prevalent among male respondents (61.5%, n = 16) than female respondents (48.1%, n = 25), although this difference was not statistically significant (P >0.05).

Conclusions: Over 96% of respondents felt they have chosen the right career and that flexibility and a good working environment are important to job satisfaction. Respondents felt that there are increasing demands being placed upon them by patients/parents, employers, the Regulators, the Government and Health Boards. This is leading to increased difficulty in achieving a satisfactory work/life balance, especially among male respondents.

Objective: To investigate clear aligner therapy (CAT) practice among orthodontists in the British Orthodontic Society (BOS).

Design: A cross-sectional online survey.

Methods: An electronic survey was distributed to members of the BOS in 2022. The survey comprised questions regarding respondent demographics, general use of CAT, the choice of proprietary CAT appliances, CAT planning, case selection, treatment protocols and orthodontist-reported CAT problems.

Results: Overall, there were 233 (19.5%) respondants with the majority (n = 121, 53.1%) being female. Most respondents reported practising in England (n = 171, 74.7%). The majority (n = 177, 77.3%) indicated that they used CAT in their practice, with 48.1% (n = 81) treating 1-20 patients with CAT annually. The most frequently prescribed CAT system was Invisalign (n = 138, 81.2%). One to three changes to the initial digital treatment plan were made by 72.9% (n = 121) with final tooth positions being the most common reason for adjustment (64.4%). Most (n = 97, 60.3%) rarely or never performed premolar extractions with CAT. Of the respondents, 23 12.7%) reported that they always or mostly used a remote monitoring system in conjunction with CAT, with a wide range of aligner change protocols reported. The median number of months required to complete non-extraction CAT reported by the respondents was 12. Most respondents (n = 77, 51.7%) did not feel that CAT provides superior outcomes compared with fixed appliance therapy.

Conclusion: CAT practice varied widely among the surveyed orthodontists. A predilection for the use of Invisalign and utility in less severe cases was noted.

Introduction: Soft tissue injuries are known complications of orthodontic treatment. Most of the injuries are mild, but severe complications can arise from deeper penetration or dislodgement of brackets and other foreign bodies into the surrounding tissues of the oropharynx and infratemporal fossa.

Patient concerns: The patient, accompanied by his parents, presented to the Children's Emergency Department with the concern of gradual limitation of mouth opening and eventual trismus, which occurred over a span of 2 weeks.

Clinical findings: The patient presented with trismus and slight discomfort at the left cheek region. He reported a history of gradual limitation to his mouth opening 2 weeks prior. He was wearing upper and lower fixed orthodontic appliances and the left distal end of the maxillary archwire was found to have migrated into the left infratemporal fossa.

Primary diagnoses: Left medial pterygoid muscle inflammation, or bleeding and haematoma formation, or infection within the infratemporal region.

Interventions: The maxillary archwire was removed in the Children's Emergency Department and a computed tomography (CT) scan performed subsequently confirmed the diagnosis of left medial pterygoid muscle inflammation. The patient was started on an intravenous (IV) antibiotic and a 2-day course of IV dexamethasone to reduce the muscle inflammation.

Outcome: By the second day, the patient was able to achieve a mouth opening of 6 mm, and by the second week, the mouth opening had returned to normal.

Conclusion: The potential risk of soft tissue injury and complications from orthodontic treatment is generally mild and limited. Soft tissue injuries can be avoided with careful management by the operator with the proper precautions taken. Clinicians should be familiar with the surrounding soft tissue anatomy and be aware of the potential for more severe complications and provide management or referral to the appropriate specialty accordingly.

Objective: To explore how orthognathic patients seek information during decision-making.

Design: Qualitative, cross-sectional study.

Setting: A hospital in Cumbria, UK.

Participants: Prospective orthognathic patients.

Methods: Participants were purposively recruited from joint orthognathic clinics after the original consultation. Semi-structured interviews were conducted via remote video call with nine participants aged 18-30 years. Data collection and reflexive thematic analysis occurred in parallel until thematic saturation was achieved.

Results: The central finding of this research was that patients were making informed decisions about orthognathic surgery. Four themes were identified to support this central finding including the following: (1) selective engagement with orthognathic information sources; (2) the central role of patient-specific information from professionals and peers; (3) Internet use to supplement standard information resources; and (4) concerns over information found online. The preferred source of information was verbal from the clinical team as it was trusted and person-specific. Past patients were identified as valued sources of information and establishing contact through digital social media networks was found to be a convenient alternative to face-to-face. Online information found was valued but concerns included information overload, problems establishing applicability and concerns over its credibility.

Conclusion: Orthognathic patients were making informed decisions about their treatment. This study highlights the central role of the patient-clinician interaction in decision-making, especially in providing patient-specific information. Insight into the nuances of information-seeking behaviours will better inform clinical care. Since patients frequently access online information that is decision-relevant, encouraging patients to discuss online searches will support the shared decision-making process and alleviate any concerns with information found. During consultation, explaining the purpose of an information aid rather than expecting patients to read them separately, may further enhance its usefulness in decision-making. This study identified an unmet need for visual aids, such as real-time images of postoperative recovery. These findings can inform the design of future information resources.

Objective: To correlate the clinical perception of maxillary incisor inclination from photographs of the smiling face with cephalometric measurements, using conventional incisor axis reference points and crown reference points.

Design: Cross-sectional study.

Setting: Department of Orthodontics, School of Dentistry, University of Lisbon (Portugal).

Participants: Eight orthodontists.

Methods: The perception of maxillary incisor inclination of 47 female patients (mean age 23.4 ± 1.5 years) was evaluated by eight orthodontists. The participants' photographs (smiling frontal, smiling three-quarter and smiling profile) were shown to each assessor and a continuous visual analogue rating scale was used to assess the perception of maxillary incisor inclination. Pearson's correlation and linear regression were calculated between each cephalometric measurement and the perception of incisor inclination.

Results: Anatomical crown inclination measurements U1ac-FH (r = 0.854; P < 0.01) and U1ac-SN (r = 0.845; P < 0.01) had the highest correlation values with the assessors' perception of maxillary incisor inclination. Conventional incisor axis measurements showed the lowest correlation values (r = 0.668-0.756).

Conclusion: Cephalometric measurements of the labial surface of the anatomical crown of the maxillary incisors showed the strongest correlations with the clinical perception of maxillary incisor inclination from photographs. For optimal aesthetics, the inclination of the labial surface of maxillary incisor crown should be evaluated.

Objective: To assess and compare the validity of 2D modified Easy Box and measurement of the Beta angle on standard conventional orthopantomogram (OPG) versus 3D cone-beam computed tomography (CBCT) OPG-constructed view.

Design: A retrospective agreement study.

Methods: The aim of this study was to construct an Easy Box on a standard conventional OPG and to validate this novel method by comparing it with the Easy Box method on 3D CBCT. After approval from the Ethics Committee, OPG and CBCT radiographs were obtained for the study from departmental records and five private practices in the same location (Indore, India). The radiographs were selected based on record availability and with written consent from the participants before the commencement of the study. The records were analysed to enable a comparison and to assess the accuracy of Easy Box construction on both 3D CBCT and standard conventional OPG radiographs. The location of the impacted canine within the Easy Box boundaries and the measurement of the Beta angle were determined on both views.

Results: A perfect agreement was obtained for the comparison of 3D Easy Box CBCT analysis with 2D modified Easy Box on OPG for impacted maxillary canines (Kappa = 1.0). A Bland-Altman (LoA) analysis showed no proportional bias in the comparison of the Beta angle on 3D and 2D OPG radiographs.

Conclusion: Beta angle and 2D modified Easy Box on a conventional OPG yield similar results when compared to Easy Box on 3D CBCT OPG-constructed view. The standard OPG was valuable and cost-effective, particularly in the early stages of diagnosis and treatment planning, either as a substitute or when CBCT was unavailable.

The aim of this case series was to illustrate the development of late-forming supernumerary teeth (LFST) and highlight the implications for orthodontic treatment. There are limited studies relating to the aetiology, prevalence and treatment of LFST and the cases presented here demonstrate the management of LFST within a tertiary care centre. Five cases are presented, which show various presentations and chronological ages in the development of LFST. This case series emphasises the significance of maintaining a low threshold for suspecting LFST in patients where supernumerary teeth have previously been identified. It also highlights the importance of regular clinical and radiographic reviews. Timely identification can help prevent complications and optimise treatment outcomes.