Northcroft lecture: how has the spectrum of orthodontics changed over the past decades?

Three aspects have had a significant impact on orthodontics during the last few decades: the appliances being used, the anchorage being used and finally the distribution of patients being treated. Firstly, the marketing of appliances is increasingly leading the orthodontist to outsource important aspects of treatment such as wirebending and bracket positioning. Brackets and wires are being presented as the solution to all problems and metaphysical terms such as 'intelligent design,' 'working brackets' and 'intelligent wires' are dominating advertising and reducing the impact of evidence-based treatment approaches. Secondly, the introduction of skeletal anchorage has potentially widened the spectrum of orthodontics, allowing for treatments that could not be done with conventional appliances. Biomechanical knowledge is, however, mandatory if we agree that the system should not be abused. Thirdly, the orthodontic population comprises an increasing number of adult patients, many of whom are characterized by a degenerated dentition. The treatment of these patients requires a thorough knowledge not only of biomechanics but also of the reaction of the periodontal tissues to various types of loading. They can be treated only with custom-made appliances adapting the force systems and magnitude to the patient-specific treatment goal. In summary, the orthodontic world is being split between 'appliance-driven fast-food orthodontics' where the results to a large extent are dependent on both growth and function and 'orthodontist-driven' 'slow-food' treatments attempting to push the limits of the possible in relation to complicated problems and reversal of degeneration in adult patients. The latter treatments are performed with individualized appliances adapting the force system to the patient. This paper will attempt to summarize the bearing of these factors on present orthodontics.     

Psychosocial acceptance of cleft patients: has something changed?

Objective

The main purpose of this study was to analyse the reactions of a panel (non-cleft adults) when observing cleft lip morphology. Although rehabilitation of cleft lip and palate is improving, there are still indications of social rejection of cleft patients by the people around them. Polarity profiles have been used since 1973 to measure social distance with regard to cleft patients. Because rehabilitation results and education of the society have improved in recent decades, we investigated whether social distance has been affected.

Setting

The setting of this study is the Department of Oral, Craniomaxillofacial, and Facial Plastic Surgery, University Hospital of Leipzig, Germany

Patients and participants

Using a cross-sectional study design, we enrolled a sample of adult laypersons (n = 273). For the survey, we followed the concept of photograph presentation and questionnaire investigation reported by Sergl and Schmid (1973). We presented anonymised frontal and profile pictures of the faces of 50 cleft patients and asked the laypersons to specify social distance. Three predictor variables (layperson gender, profession and year of evaluation) were grouped.

Results

Although social distance has reduced during the last 40 years, life situations which require emotional proximity still cause some concern. Professional background and gender affect laypersons’ attitudes.

Conclusion

Although rehabilitation of cleft lip and palate is much better than 40 years ago, social distance remains a problem in society. It is necessary to improve both results of rehabilitation of cleft patients and social acceptance by the people around them.

     

Concepts on orthodontics of the future: speculation or illusions?

Due to complex computer modeling it will soon be possible in the future to evaluate orthodontic protocols with systems biology for the dentofacial complex. Also one will be able to simulate the processes of development of the teeth and the head this way, as well as environmental factors influencing these processes. It is certain that everything that is already used in other biological systems, will one day also be used in the dentofacial system and from there also in orthodontics. Before it comes to that, a lot of data still remain to be gathered by reductionistic experiments.     

How has the dental literature evolved over time? Analyzing 20 years of journal self-citation rates and impact factors

Abstract

Objective: As journal impact factors (IFs) can be artificially inflated by excessive journal self-citation practices, research quality evaluation based solely on IF ranking may be manipulated and, therefore, ethically challenged. This study aimed to analyze the longitudinal development of journal self-citation rates (SCRs) and IFs in dental literature and to determine possible confounders.

Methods: Twenty-eight journals with scope within general dentistry and (sub)specialties listed in 1997–2016 Journal of Citation Reports^® were scrutinized. The following information was retrieved: publication year, total number of citations, number of self-citations, IF, corrected IF, and SCR.

Results: Endodontic journals had the highest SCR (median = 35.3, IQR = 21.6–47.5), journals related to periodontics had the lowest (median = 14.7, IQR = 8.9–25.5). Periodontics had the highest IF (median = 2.1, IQR= 1.7–2.8) and general dentistry had the lowest (median = 0.9, IQR = 0.7–1.2). SCR significantly decreased over time (p?<?.0001) by 1 unit per year. Additionally, 1 unit increase in corrected IF resulted in 15.2 units decrease in SCR. IFs significantly increased 0.06 units per year (p?<?.000).

Conclusions: Overall, favourable changes in citation metrics have been observed for dental journals during the 20-year observation period. SCR significantly decreased per observation year whereas IFs significantly increased, indicating a healthy publishing environment in the dental literature. SCR was regulated both by time and corrected IF.     

How has genomics altered our view of caries microbiology?

Genome sequencing and other molecular techniques for the identification and characterisation of bacteria have provided us with a vast amount of new information, both on the detailed properties of certain species and on the total plaque microflora. Thus, from genomics, we have gained many valuable insights into the biology of Streptococcus mutans and the diversity within the species, while molecular techniques of identification have prompted a heightened awareness of the importance of species other than S. mutans to the caries process. S. mutans remains deserving of detailed study, both as an exemplar of an acidogenic, aciduric plaque bacterium and because it shows a strong association with caries. Nevertheless, its value as a target for inhibitors and its usefulness as an indicator organism for monitoring the value of caries prediction or prevention need to be evaluated in the light of new discoveries.     

Taking stock: passing the torch,who has the light? Reflections about teaching orthodontics at the occasion of the retirement of Prof. Lysle E. Johnston,Jr PhD

In the Marburg (Germany) 5-year dental curriculum, students enter the orthodontic department in the middle of their third year. Our teaching is student-centered and problem-solving oriented. From day 1 our students are trained to diagnose in three separate levels of development i.e. (i) craniofacial growth, (ii) development of the dentition and (iii) maturation of function. These three levels are kept separate throughout patient examination and up to the strategic treatment planning phase. The examination is performed with the help of three checklists, one for the facial morphology, one for the dentition and one for function. The three resulting problem lists then undergo reduction by selecting one 'key problem' for each level. Next, for every key problem three 'standard solutions' are offered, not in the form of appliances but as vectors that can modify growth. Finally, in a strategic planning phase, one treatment option from each of the three levels is selected and combined in a single, be it hypothetical, treatment plan. Parallel to these, students are exposed to treatment mechanics through the presentation of selected orthodontically treated patients. In our experience the advantage of this diagnostic procedure lies in the structured organization that serves as a GPS system for student and teacher and enables them a clear communication about where they are and what has to be done. By design, treatment options have taken priority over treatment mechanics. We are confident that our students, equipped with real life diagnostic skills, are well prepared for their orthodontic future.     

Present and the future of digital orthodontics✰

Digital technology had significant impact into our life since the introduction and sophistication of mobile phones. Medical diagnosis, teaching tools, treatment modalities and surgical technics were improved significantly with the help of digital technology during the last two decades. Digital technology started to make its way into dental and orthodontic offices with the introduction of computerized scheduling in the 1974. Today digital technology has touched on every aspect of orthodontic treatment. It is now common place to perform virtual treatment planning as well as translate the plans into treatment execution with digitally driven appliance manufacture and placement using various CAD/CAM techniques from printed models, indirect bonding trays and custom made brackets to robotically bent wires. Furthermore it is also becoming possible to remotely monitor treatment and control it.     

Adult orthodontics in the Republic of Ireland: specialist orthodontists’ opinions

Objectives: To report the opinions of specialist orthodontists regarding the profile, characteristics and treatment of adults currently undergoing orthodontic treatment in the Republic of Ireland (ROI)

Design/setting: A national cross-sectional questionnaire study in the ROI.

Method: A pilot-tested questionnaire was distributed to 122 specialist orthodontists in the ROI. Questions addressed general and treatment information for current adult orthodontic patients. Those whose treatment involved orthognathic surgery were not excluded.

Results: A response of 83% was obtained. Ninety-five per cent of specialists reported treating adults, most of whom were self-referred and were typically professional, female and aged 25–35 years. The overall ratio quoted of professionals to non-professionals was almost 3:2. For 50% of specialists, males were estimated to account for 20–40% of their adult cases and for 23%, this increased to an estimated 40–60%. Class II division 1 malocclusion and skeletal II were considered the most common dentofacial characteristics. Occlusal features encountered in decreasing frequency were generalised crowding, increased overjet, deep overbite, late lower incisor crowding, spacing and impacted teeth. Fifteen per cent reported that at least 10% of their adult cases required orthodontics with maxillofacial surgery but 8% reported that this was at least 50%. Treatment challenges commonly acknowledged were overbite reduction, anchorage management, ‘black triangles’ and overjet reduction. Tooth whitening was reckoned to be used by 19% of specialists. Aesthetic upper and stainless steel lower brackets were indicated to be used most often whereas only 19% used clear aligners and 10% used lingual appliances often.

Conclusions: The profile and characteristics of adults currently undergoing orthodontic treatment in the ROI were diverse. Higher estimates were quoted for self- than for general dental practitioner-referral. A high percentage of treatment was reported to be undertaken for non-professionals and males. A wide range of treatment and varying use of appliance types were cited.     

The standard of care in dentistry: Where did it come from? How has it evolved?

BACKGROUND: The author explores the topic of the standard of care. He reviews the initial application of the standard to health care professionals, as well as its evolution from an 1898 legal case in which 10 elements of the standard of care were stated. CONCLUSIONS: The standard of care continually evolves with the advent of new materials, new procedures and new court rulings. Before applying the standard of care, dentists should consider new available treatments, as well as their state's current interpretation of the standard of care. PRACTICE IMPLICATIONS: The standard of care should be applied to all dentists when patients claim alleged malpractice. It should be tempered by changes in the practice of dentistry, which dentists should be aware of.     

Has the level of dental fluorosis among Toronto children changed?

We conducted a survey during the 1999 2000 school year to obtain valid estimates of the oral health status of a probability sample of children in the 4 regions of the newly amalgamated city of Toronto. The results will be used in developing recommendations for programs to address the oral health problems identified. The Dental Indices System is the Ontario protocol whereby information on the oral health status and treatment needs of children can be obtained by direct assessment of the children. One of 2 specially trained dental hygienists examined each child's teeth and periodontal tissues using sterilized mouth mirrors and blunt probes with a standard light source. Overall, there were 3657 participants in the survey, of whom 2435 were aged 7 or 13 years; these 2 age groups formed the basis for the analysis. Forty percent of those aged 7 or 13 had had one or more decayed teeth. Approximately 7% of children in the younger age group had at least one condition requiring urgent care. Dental fluorosis of moderate severity (Tooth Surface Index of Fluorosis 2) was found among 14.0% of 7-year-olds, 12.3% of 13-year-olds and 13.2% of the 2 age groups combined. The prevalence of fluorosis was of the same order as all but one of the more recent studies performed in Toronto. The prevalence may fall as the recently imposed reduction in concentration of fluorides in city water takes effect. On the basis of these findings of fluorosis, Toronto Public Health should continue to monitor levels of dental fluorosis and caries and should continue its efforts to inform parents of very young children about the safe use of fluoridated dentifrice.