A Thousand Consecutive Treated Orthodontic Cases—A Survey

Abstract

An analysis of 1000 consecutive treated cases from a private orthodontic practice was made. Inter alia the results show: the male to female ratio was 4: 6; the mean age of first attendance was 10·7 years and the mean age at the start of active treatment was 11·6 years. 49 per cent of the cases were Angle Class I; 39 per cent Class II/1; 8 per cent Class II/2 and 4 per cent Class III. Over half the patients had an increased overbite. 21 per cent had an anterior crossbite and 11 per cent showed a posterior crossbite. Approximately 75 per cent of the cases showed crowding of the labial segments. There was crowding in 26 per cent of the upper buccal segments and in 49 per cent of the lower ones.

93 per cent of the patients received active treatment for the upper arch but only 4 per cent had appliances in the lower arch. A quarter of the cases were treated without upper extractions; in the lower arch the figure was 58 per cent. 94.1 per cent of the patients were treated with removable appliances requiring, on average, 1·5 appliances per case to complete treatment. 30 per cent of the cases received no retention. 54 per cent wore a retainer for less than 6 months.

88 per cent of the patients completed treatment and co-operation was satisfactory in 87 per cent. The mean treatment period for each patient was 13·1 months involving an average of 11·7 visits. The average active treatment time for each patients was 95 minutes. 74 per cent of the completed cases had a satisfactory result.

The discussion supports the case for relating the type of orthodontic treatment to the total dental need of the patient. This requires more knowledge of what is meant by “dental health”. A plea is made that orthodontists should not become rigid in their approach to treatment.     

Orthodontic treatment need and demand in 12-14-year-old north Jordanian school children

This study was undertaken to assess the need and demand for orthodontic treatment among 12-14-year-old north Jordanian school children. In total, 1002 students randomly selected to represent five geographical areas of Irbid were examined. The examinations were carried out twice, first on the pupils in the school premises and then using study models taken from each student. The dental health (DHC) and aesthetic (AC) components of the Index of Orthodontic Treatment Need (IOTN) were used as an assessment measure of the need for orthodontic treatment. The demand for orthodontic treatment was measured by asking the students 'if it was necessary, would they like to have their teeth straightened by an orthodontist'. The results showed that approximately one-third (34 per cent) of the children examined had a definite need for orthodontic treatment. Within this group, 73.5 per cent were in need of orthodontic treatment according to the DHC, 23.5 per cent had both DHC and AC great need scores, and 3 per cent were in need according to the AC only. Severe contact point displacement of more than 4 mm was the most common occlusal feature in the definite treatment need group, followed by impeded eruption of teeth, hypoplasia of a single tooth and increased overjet of more than 6 mm but less than or equal to 9 mm. The demand for orthodontic treatment among the students was 49 per cent. Approximately half of them (54 per cent) had a definite need for orthodontic treatment. This study provides baseline data on the need and demand for orthodontic treatment among a Jordanian population, which is important for planning public orthodontic and dental services.     

Success rate and efficiency of activator treatment

In a retrospective multicentre study, the success rate and efficiency of activator treatment were analysed. All patients from two University clinics (Giessen, Germany and Berne, Switzerland) that fulfilled the selection criteria (Class II division 1 malocclusion, activator treatment, no aplasia, no extraction of permanent teeth, no syndromes, no previous orthodontic treatment except transverse maxillary expansion, full available records) were included in the study. The subject material amounted to 222 patients with a mean age of 10.6 years. Patient records, lateral head films, and dental casts were evaluated. Treatment was classified as successful if the molar relationship improved by at least half to three-fourths cusp width depending on whether or not the leeway space was used during treatment. Group comparisons were carried out using Wilcoxon two-sample and Kruskal-Wallis tests. For discrete data, chi-square analysis was used and Fisher's exact test when the sample size was small. Stepwise logistic regression was also employed. The success rate was 64 per cent in Giessen and 66 per cent in Berne. The only factor that significantly (P < 0.001) influenced treatment success was the level of co-operation. In approximately 27 per cent of the patients at both centres, the post-treatment occlusion was an 'ideal' Class I. In an additional 38 per cent of the patients, marked improvements in occlusal relationships were found. In subjects with Class II division 1 malocclusions, in which orthodontic treatment is performed by means of activators, a marked improvement of the Class II dental arch relationships can be expected in approximately 65 per cent of subjects. Activator treatment is more efficient in the late than in the early mixed dentition.     

The Use of the Index of Orthodontic Treatment Need (IOTN) in a School Population and Referred Population

Abstract

The aim of this study is to assess the need for orthodontic treatment in a Turkish school population and a group of population referred for orthodontic treatment. The study groups were 250 school children, 11–14 years of age, and 250 patients, 11–14 years of age, referred to the department of orthodontics. The Index of Orthodontic Treatment Need (IOTN) was used by two examiner in order to estimate the treatment need. The differences between the IOTN values for the boys and girls were also not statistically significant in both groups. When the dental health component of IOTN is considered, 38?8 per cent of Turkish school population showed great need treatment, 24?0 per cent moderate need treatment and slight or no need was 37?2 per cent. On the other hand, the referred population represented an 83?2 per cent great need treatment, 12?0 per cent moderate need treatment, 4?8 per cent no need treatment according to the DHC.

The AC of IOTN in school population resulted in 4?8 per cent great need, 4?8 per cent moderate need, 90?4 per cent no need. These percentage were 36?8 per cent great need, 17?6 per cent moderate need, 45?2 per cent no need in referred population. Grade 8 was 28?8 per cent out of the 36?8 per cent great need percentage in referred population. Therefore, it can be concluded that the ectopic canines were the driving factor for the referred population.     

外科矫正骨型下颌下后缩畸形的术前术后正畸治疗

以近期连续收治的１７例骨型严重下颌后缩的患者为例，重点介绍对该类畸形患者的术前准备，特别是术瓣术后正畸治疗及Ｈｅ导板的应用。正畸治疗内容包括；去代偿扩大上牙弓，排齐牙齿，平整Ｈｅ曲线，使上下牙弓形态协调，恢复Ｈｅ平衡重建良好的咬合关系。     

外科矫正骨型下颌后缩畸形的术前术后正畸治疗

以近期连续收治的 17例骨型严重下颌后缩 (已作正颌手术 )的患者为例 ,重点介绍对该类畸形患者的术前准备 ,特别是术前术后正畸治疗及导板的应用。正畸治疗内容包括 :去代偿扩大上牙弓 ,排齐牙齿 ,平整曲线 ,使上下牙弓形态协调 ,恢复平衡重建良好的咬合关系。作者的经验表明 ,对严重骨型下颌后缩患者 ,要获得形态和功能完美结合的理想治疗目标 ,外科和正畸联合治疗 ,特别是术前、术后的正畸准备 ,是保证手术成功的必须和必要的条件。     

Prevalence of malocclusion and orthodontic treatment need in children and adolescents in Bogota, Colombia. An epidemiological study related to different stages of dental development

The aim of the study was to assess the prevalence of malocclusion in a population of Bogotanian children and adolescents in terms of different degrees of severity in relation to sex and specific stages of dental development, in order to evaluate the need for orthodontic treatment in this part of Colombia. A sample of 4724 children (5-17 years of age) was randomly selected from a population that attended the Dental Health Service; none had been orthodontically treated. Based on their dental stages the subjects were grouped into deciduous, early mixed, late mixed and permanent dentition. The registrations were performed according to a method by Bj?rk et al. (1964). The need for orthodontic treatment was evaluated according to an index used by the Swedish National Board of Health. The results showed that 88 per cent of the subjects had some type of anomaly, from mild to severe, half of them recorded as occlusal anomalies, one-third as space discrepancies, and one-fifth as dental anomalies. No clear sex differences were noted, except for maxillary overjet, spacing, tooth size (all more frequent in boys), and crowding (more frequent in girls). Occlusal anomalies and space discrepancies varied in the different dental developmental periods, as did tipped and rotated teeth. Little need for orthodontic treatment was found in 35 per cent and moderate need in 30 per cent. A great need was estimated in 20 per cent, comprising children with prenormal occlusion, maxillary overjet, or overbite (> 6 mm), posterior unilateral crossbite with midline deviation (> 2 mm), severe crowding or spacing, congenitally missing maxillary incisors, impacted maxillary canines or anterior open bite (> 3 mm in the permanent dentition). Urgent need for treatment was estimated to be 3 per cent, comprising subjects with extreme post- and pre-normal occlusion, impacted maxillary incisors or extensive aplasia.     

Conference Report

Abstract

The criteria that dentists use to judge the need for orthodontic treatment are not clear. This study investigates variation in dentists' perception of orthodontic treatment need. Seventy-four dentists were asked to assess 320 dental casts in relation to aesthetic and dental health need. The results of this investigation revealed that the panel was divided as what constituted a need for orthodontic treatment on dental health grounds. It is suggested that one method of achieving a more uniform evaluation of orthodontic treatment need is the use of an occlusal index. Until an occlusal index is accepted and used by the profession, the distortion of need and demand for orthodontic treatment by dentists' unequal perceptions will continue.     

An index of orthodontic treatment complexity

The aim of the present study was to develop an index specifically for the measurement of treatment complexity. Input factors were directly related to complexity, and the output was a score measuring the degree of treatment complexity. The sample comprised 120 sets of dental casts, 30 for each of the four main malocclusion classes. Sixteen orthodontists graded the study casts for perceived treatment complexity on a six-point scale and then listed, in order of importance, up to three occlusal features which they felt contributed to complexity from a pre-determined list. Multiple regression analysis was used to derive weightings for each occlusal feature, which would reflect the relevant treatment complexity. In order to obtain an overall treatment complexity score for each case, weightings were then multiplied by the corresponding occlusal feature scores and summed. The relationship between treatment complexity scores and perceived complexity was examined using Spearman's ranked correlation coefficient. The regression equation explained 49.5 per cent of the variance in treatment complexity of the whole sample. Regression analysis on the basis of malocclusion produced R (2) values of 90.7 per cent for Class I, 42.6 per cent for Class II division 1, 62.3 per cent for Class II division 2, and 79.5 per cent for Class III malocclusions. The index of orthodontic treatment complexity (IOTC) scores showed a moderate but highly significant association with the orthodontists' perceived complexity assessments (rho = 0.42, P = 0.000). The proposed IOTC shows sufficient promise to warrant further development.     

Occlusal traits,orthodontic treatment need and treatment complexity among untreated 17–21-year-olds in Estonia

Objective: To analyze data on occlusal traits, orthodontic treatment need and treatment complexity in orthodontically untreated 17–21-year-old Estonians.

Materials and methods: Clinical records and plaster casts of 390 untreated young adults (219 females and 171 males, mean age 18.5 years, range 17–21 years) were analyzed. Assessed occlusal traits included first molar and canine sagittal relationship, overjet, overbite, crowding, midline diastema, crossbite and scissor bite. The Index of Complexity, Outcome and Need (ICON) was used to assess orthodontic treatment need and complexity. Participants’ opinions regarding their teeth were determined with a questionnaire.

Results: The most prevalent occlusal traits were Class I sagittal relationship in canines (76%) and molars (70%), crowding (51%), overbite ≥3.5?mm (48%), the end-to-end sagittal relationship in canines (48%) and overjet ≥3.5?mm (47%). Antero-posterior asymmetry was common both in canines (39%) and molars (37%). According to ICON, 36% of participants had orthodontic treatment need.

Conclusions: Desire for orthodontic treatment was associated with crowding and increased overjet, and with no gender difference, participants’ main expectation of treatment was an improvement in dentofacial aesthetics. Treatment needs determined with ICON was moderate and in line with the participants’ desire for orthodontic treatment.     

Orthodontic Treatment in the General Dental Service Assessed by the Occlusal Index

Abstract

As with all other aspects of health care, orthodontic treatment should be evaluated in as objective a manner as possible.

In this study, the models of a sample of 256 patients treated by appliance therapy in the General Dental Service were examined. The Occlusal Index was first refined and variability in its use due to articulation and measurement errors was assessed. It was then used to quantify occlusal status both before and after treatment, and thereby monitor changes brought about by treatment.

The mean Occlusal Index score at the beginning of treatment was 9·9. At the end of treatment, the mean score had dropped to 5·5. There was wide variation among individual cases, but some reduction was found in 88 per cent of instances. In 56 per cent of cases the reduction ranged up to 6 units, while in 29 per cent of cases the reduction was 6–12 units. However, in cases which started with a marked malocclusion, only about one-third showed a sizeable improvement. In about one-third of all cases there was little improvement in the malocclusion.

While there is room for further refinement of the Occlusal Index to increase its usefulness in quantifying occlusal status brought about during orthodontic treatment, the present findings provide a basis for future comparisons.     

Association between occlusal anomalies and dental caries in 3‐ to 5 year‐old Brazilian children

Abstract

Objective: To investigate the association between certain occlusal anomalies and the occurrence and severity of dental caries in Brazilian preschool children.

Design: Cross‐sectional study.

Setting: Twenty‐eight public nursery schools in Canoas, southern Brazil.

Subjects and methods: The study population comprised 890 three‐ to five‐year‐old children. Five trained and calibrated observers examined children for determination of decayed, missing and filled tooth (dmft) index (World Health Organization criteria including white spots) and orthodontic variables.

Outcome measures: Caries severity (dmft) and caries occurrence (dmft?1).

Statistical analysis: Multivariable analysis was performed using Poisson regression with robust variance in order to determine the occlusal anomalies which represent risk factors for the occurrence of the binary outcome.

Results: Caries severity was significantly higher among children without spacing in the maxillary anterior teeth (P?=?0·001) and mandibular anterior teeth (P?=?0·003) and among children without accentuated overjet (P?=?0·023). The multivariable analysis demonstrated that children without spacing in maxillary anterior teeth had an increased risk of dental caries (prevalence ratio?=?1·43; 95% CI, 1·05–1·93). Open bite, accentuated overjet and posterior cross‐bite were not associated with this outcome in the final model.

Conclusions: Absence of spacing in the maxillary labial segment represents a risk factor for dental caries in preschool children.     

Occlusal interferences in orthodontic patients before and after treatment,and in subjects with minor orthodontic treatment need

Different opinions have been expressed concerning the effect of orthodontic treatment on mandibular function. One factor discussed is occlusal interferences. The aim of this study was to establish the prevalence of occlusal interferences in 210 orthodontic patients before (mean age 12 years 8 months) and after (mean age 16 years 10 months) treatment and to compare them with subjects with minor orthodontic treatment need. The results showed a decrease in retruded contact position/intercuspal position (RCP/ICP) interferences in all morphological deviations, age, and gender groups. The prevalence of mediotrusion interferences decreased in some types of malocclusions whilst in others there was no change. One reason for this is that treatment was started when the majority of the patients had no second or third molars erupted. At the final registration, the second molars were erupted in all patients, and the third molars were erupted in approximately 25 per cent. Mediotrusion interferences were more consistent with basal morphological deviations, for example, Class III relationships and anterior open bite were more consistent in the same person, and more difficult to eliminate than RCP/ICP interferences. RCP/ICP interferences, often caused by dental deviation in position, size, and shape, were easier to correct. Optimal orthodontic treatment, if necessary, including selective grinding, will decrease the prevalence of occlusal interferences.     

Occlusal traits in a group of school children in an isolated society in Jerusalem.

Abstract

The prevalence of occlusal features in 939 children, aged 6-13 years, belonging to an ultra-orthodox community of Jewish Ashkenazi descent living in Jerusalem was studied clinically. Sexual dimorphism was found for overjet, overbite, and habit practising. About one-quarter of the sample exhibited some degree of occlusal mutilation due to caries, thus creating a 'caries-affected' subgroup, the rest forming the 'caries-free' subgroup. In the latter set, normocclusion was scarce (7.4 per cent), Class I being the most frequent malocclusion (49.1 per cent). Caries had a significant effect on the symmetry of bilateral occlusal relationships, lower dental midline deviation, and on crowding/spacing conditions in the mixed dentition stage (except for the maxilla in late mixed dentition). The low prevalence of normocclusion can be attributed to genetic background, environmental influences and the definition attached to normal occlusion.     

减小后牙▉平面倾斜度对安氏Ⅱ类高角畸形髁突位置影响的研究

目的: 研究在安氏Ⅱ类高角畸形正畸治疗中,减小后牙平面倾斜度对髁突位置的影响。方法: 15例安氏Ⅱ类高角畸形患者,年龄15~30岁。治疗前ANB>5°,下颌平面角FH-MP>32°,磨牙关系为双侧远中关系。常规排齐整平及适当扩弓后,利用多曲唇弓导下颌向前,并使后牙平面平坦化。利用锥形束CT（cone-beam CT,CBCT）测量治疗前、后颞下颌关节前、上、后间隙及后牙平面的改变情况。采用SPSS19软件包对变化量进行t检验;并利用相关性分析,进一步探讨髁突位置改变量与后牙平面倾斜度减小量之间的相关性。结果: 所有患者磨牙尖牙关系均调整到中性,侧貌改善明显,髁突后间隙平均增加(0.88±0.17)mm,变化有统计学意义(P<0.001);髁突上间隙平均增加(0.45±0.20)mm,变化也具有统计学意义(P<0.05)。后牙平面变平坦,POP-SN及POP-FH平均减小3.59°±2.31°及2.31°±3.62°,变化具有统计学意义(P<0.001)。髁突前间隙变化量无统计学意义,髁突位置改变量与后牙平面倾角的变化量之间无显著相关性。结论: 在安氏Ⅱ类高角畸形患者的正畸治疗中,通过正畸减小后牙平面倾斜度,可使髁突的位置发生适当的前下改变,有利于关节症状的改善。     

Mandibular premolar autotransplantation in cleft affected patients: The replacement of congenital missing teeth as part of the cleft patient's treatment protocol

BackgroundTooth autotransplantation has developed into a safe and predictable procedure, which preserves the continuity of the dental arch and the alveolar process and provides an acceptable aesthetic and physiological outcome.AimTo describe our experience with autotransplantation of the developing mandibular premolar to the iliac crest grafted alveolar cleft as part of the cleft patient's treatment protocol.Material and methodsFour cleft affected patients were referred to the Orthodontic and Craniofacial Department, Rambam Health Care Campus, Haifa, Israel due to loss of teeth in the cleft area. In all cases, orthodontic closure of the missing teeth space in the maxillary dental arch was considered inappropriate and therefore autotransplantation of the extracted mandibular premolar to the bone-grafted alveolar cleft site was conducted.ResultsNone of the transplanted teeth in the reported cleft affected patients had signs or symptoms of progressive root pathology, gingival disease or advanced tooth mobility. Long-term clinical follow-up examination revealed improved facial aesthetics and occlusal relationships along with increased self-esteem and welfare of the patients' with no need for future dental restorative treatment.ConclusionAutotransplantation of mandibular premolars should be considered an alternative to prosthodontics in cleft affected patients as an integral part of the cleft patient's treatment protocol.     

Functional Occlusion: I. A Review

Abstract

The features that constitute an ‘ideal’ functional occlusion have not been conclusively established.Orthodontic treatment has the capacity to change static and functional occlusal relationships fundamentally.In this article, we present the evidence on which features of the occlusion are reported to be detrimental to the teeth and masticatory system Deficiencies in this research area are highlighted, together with the need for prospective longitudinal trials to clarify the requirements of an ideal functional occlusion Based on the existing evidence this paper suggests which occlusal features may be significant in producing an ‘ideal’ functional occlusion As no long-term studies exist to measure the impact of non-ideal occlusal relationships on the dentition, it is debatable whether orthodontic treatment should be prolonged in order to ensure that ‘ideal’ occlusal contacts are achieved As the occlusion tends to ‘settle’ in the period following appliance removal, we propose that it may be more appropriate to examine the functional occlusal relationships after retention has ceased rather than prolong active orthodontic treatment to achieve ‘ideal’ functional occlusal goals.     

Arch perimeter changes on rapid palatal expansion

Relationships between changes in arch perimeter and arch width resulting from rapid palatal expansion with the Hyrax appliance were analyzed with the use of dental study casts of 21 adolescent patients. Photographs and measurements from the dental casts obtained before treatment and approximately 3 months after stabilization were used. Regression analysis indicated that changes in premolar width were highly predictive of changes in arch perimeter (r2 = 0.69) at approximately 0.7 times the premolar expansion. Without any orthodontic appliances attached to the mandibular teeth in 16 of the 21 patients, buccal uprighting of the posterior teeth was observed because of the redirection of occlusal forces. In addition, posterior movement of the maxillary incisors and buccal tipping of the anchor teeth were quantified. The prediction of arch perimeter change for a given amount of expansion is helpful in the treatment planning of rapid palatal expansion cases and may facilitate nonextraction orthodontic treatment.     

Attitudes and satisfaction with dental appearance in young adults with and without malocclusion

The aim of the study was to assess the quality of a Public Dental Service (PDS) system in Sweden with regard to the orthodontic care and to investigate the selection made for the consultation by the general practitioners (GPs) and by orthodontists of those patients with malocclusion. In the individuals leaving the PDS system, the residual need and demand for treatment due to malocclusions and satisfaction with and opinion of their teeth was assessed in orthodontically treated and untreated 19-year-olds. Altogether 121 19-year-olds were clinically investigated with respect to six defined malocclusion traits and given a questionnaire. The following results were found: Ten per cent of the 19-year-olds that had not had an orthodontic consultation showed a residual treatment need. One third of the individuals judged by the orthodontist not to need treatment and one third that had been treated by the GP showed a marked orthodontic treatment need at the age of 19 years. Twenty-two per cent of all 19-year-olds left the PDS with an orthodontic treatment need. Ninety-four per cent were satisfied with their teeth irrespective of malocclusion or not. Every second individual considered their teeth important for their self-esteem. It was concluded that 19-year-olds in general were satisfied with their dental appearance. Half of the registered residual need and demand for orthodontic treatment was not related to measurable malocclusions.     

Shortened Dental Arch and Cerebral Regional Blood Volume: An Experimental Pilot Study with Optical Topography

Abstract

A shortened dental arch without posterior occlusal support has been thought to maintain sufficient oral function. The mechanism of occlusal adaptation with a shortened dental arch is unclear. For a better understanding of the effects of molar teeth on brain function, the authors combined experimentally- shortened dental arches and a neuro-imaging technique. Regional cerebral blood volume was measured using near-infrared optical topography during maximum voluntary clenching tasks from 10 subjects on individually fabricated oral appliances, which can create experimentally complete and shortened dental arches. Results suggested that clenching on the complete dental arch showed a significantly higher brain blood volume than that on the shortened dental arch. Moreover, there were no differences between the two splints in the latency to the maximum oxyhemoglobin concentration. These findings suggest that occlusal status is closely related to brain blood flow and lack of occlusal molar support rapidly reduces cerebral blood volume in the maximum voluntary clenching condition.