Journal of Orthodontics最新文献

Objectives: To evaluate the characteristics and content of YouTube™ videos created by patients undergoing orthodontic fixed appliance treatment and to assess the content accuracy of these videos.

Design: A mixed-methods quantitative and qualitative study.

Data source: YouTube™ webpage.

Methods: The term 'braces' was used to search for relevant videos on the YouTube™ webpage between 18 August and 30 August 2020, with no limits imposed regarding how long the video had been available on YouTube™. Videos were included if they were made by patients and were predominantly about patients' experiences during treatment with labial fixed appliances. The main themes/subthemes of the included videos were identified. A checklist was then developed to assess accuracy of the video content for two of the main themes and the videos were assessed against the checklist.

Results: The video search identified 350 videos, of which 64 were selected as potentially eligible; 41 were subsequently excluded as they related primarily to the bond up/debond experience or had minimal information about orthodontics. This meant that 23 videos were ultimately included for analysis. Six main themes were identified in the videos: problems with fixed appliances, effects of fixed appliances, oral hygiene maintenance, dietary advice, treatment duration/appointment frequency and auxiliaries used with fixed appliances. From the 23 videos, 20 were assessed against the checklist for content accuracy related to two selected themes: oral hygiene maintenance and dietary advice. The majority of videos had low content accuracy scores, indicating that important and relevant content was generally missing.

Conclusion: Several included videos focused on oral hygiene maintenance and dietary advice associated with fixed appliances; however, the content was incomplete and not always accurate. This is concerning to the profession, and it is therefore recommended that clinicians consider collaborating with patients to produce videos that are patient-centred and that also contain accurate information.

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 apply the Peer Assessment Rating (PAR) to cases that have been assessed by the NHS Business Service Authority (NHSBSA) using the orthodontic treatment protocol (OTO), then compare the NHSBSA outcome assessment with weighted (W) and unweighted (U) PAR scores.

Design: Cross-sectional study.

Setting: UK.

Cases: Anonymised orthodontic cases submitted to the NHSBSA.

Methods: A sample of 30 reports from 2021/2022 were randomly selected to include different standard of treatment grades. The records were de-identified and the pre- and post-treatment study models were PAR scored by a calibrated assessor.

Results: The mean percentage change in PAR was higher in cases from green reports (W: 78%; U: 79%) than amber (W: 68%; U: 67%) and red reports (W: 65%; U: 65%). Alignment and poor buccal segment interdigitation were the most reported concerns for cases included in the red and amber graded reports. A residual increased overjet was the most common occlusal feature leading to PAR scores not being more than 70% improved. Only slight agreement was shown between OTP and PAR using the kappa statistic, and the chi-square statistical test found that outcome measures are statistically significantly different.

Conclusion: There are fundamental differences between OTP and PAR, and general agreement between them has not been demonstrated. The NHSBSA Report provides a more critical outcome assessment than PAR, identifying elements that are not assessed or measured by the PAR index.

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.