The knowledge and attitudes of orthodontic trainees towards orthodontic therapists: a national survey

Objective: To assess the knowledge and attitudes of orthodontic trainees towards orthodontic therapists (OTs) in the UK.

Design: Cross-sectional survey.

Setting: UK-based orthodontic trainees.

Materials and methods: An electronic survey was sent to all members of the Training Grades Group of the British Orthodontic Society assessing exposure to OTs and their knowledge regarding current supervision guidelines and scope of practice. Attitudes towards OTs were also explored.

Results: Seventy-six responses (response rate 57%) were returned. Nearly 90% of trainees had no formal training regarding OTs. A total of 15.5% were aware of the correct current supervision guidelines and there was large variation in the knowledge of OTs’ scope of practice. The majority of trainees were happy to supervise OTs, but only 22.4% felt prepared for this during training. In total, 63% of trainees felt that OTs could impact their own future job prospects.

Conclusions: Currently, there is minimal formal training provided to trainees regarding the role of OTs. This is reflected in the lack of knowledge regarding supervision guidelines and scope of practice. Overall, trainees felt OTs were positive for the workforce but were concerned regarding the impact of their own future employment.     

How do patients perceive the British orthodontic society online information resource about orthognathic treatment? A qualitative study

Objectives: To explore the accessibility, usability and relevance of the British Orthodontic Society (BOS) online information resource (OIR), Your Jaw Surgery.

Design: Qualitative, cross-sectional study.

Setting: 5 UK sites.

Participants: Patients before, during and after treatment for non-cleft skeletal discrepancy.

Methods: Patients were identified at joint clinics and recruited after having time to view the OIR. Semi-structured interviews were conducted with 17 patients (aged 16–46 years). The interviews were transcribed and thematic analysis was undertaken using a framework approach.

Results: The main themes identified were the overall usefulness, personal relevance and positive perceptions of the OIR. The OIR was seen to be useful for patients considering treatment, and potentially useful for patients undergoing treatment. Participants were looking for a personally relevant resource that would give them the best possible idea of how they would look and feel after surgery. The OIR was perceived as trusted, positive and reassuring.

Conclusions: Patients at different stages of treatment found the OIR helpful and reassuring. Clinicians may find it useful to direct patients to the OIR to complement a professional consultation, but should be aware that patients may perceive it as presenting a positive image of the long-term benefits of orthognathic surgery.     

Oral appliances for the treatment of obstructive sleep apnea in patients with low C-PAP compliance: a long-term case series

Objectives:

To assess the effectiveness of mandibular advancement devices (MADs) for the treatment of obstructive sleep apnea syndrome (OSAS) over a long-term follow-up in patients non-compliant with continuous positive airway pressure (CPAP) and to identify potential predictive factors of response to MADs.

Methods:

Fifteen OSAS patients were enrolled. Apnea-hypopnea index (AHI) and daytime sleepiness were assessed at baseline and at the end of follow-up. Potential baseline predictors of treatment effectiveness were assessed.

Results:

AHI and Epworth Sleepiness Scale (ESS) scores improved significantly with MADs. Sixty per cent of patients were ‘responders’, of whom 33% were ‘full responders’. Sixty-seven per cent of patients showed total compliance. No correlations between the potential predictors and the response to MAD therapy were found.

Discussion:

Effectiveness of MAD therapy was shown over a long-term follow-up in OSAS patients with low compliance to CPAP. Efforts to identify predictive success factors fell short.     

Conservative reduction by lever action of chronic bilateral mandibular condyle dislocation

Aims:

The treatment of long-standing dislocation of the temporomandibular joint is broadly classified into open reduction and closed reduction. The current study presents a case of long-standing dislocation of the temporomandibular joint treated 3 years after dislocation. In this study, the authors evaluated the long-term outcome of conservative reduction by lever action of chronic bilateral mandibular condyle dislocation.

Methodology:

Manual repositioning of temporomandibular joint dislocation lasting for 3 years in a 31-year-old woman was attempted without success; therefore, conservative reduction by lever action was carried out because the patient declined treatment under general anesthesia.

Results:

The treatment was discontinued after 6 days because of the subluxation of the retaining tooth. The retainer was changed from tooth to screw for intermaxillary fixation, and treatment was reinstituted. Fifteen days later, reduction was achieved and retention was started and continued for 2 months. The outcome was good, with no recurrent dislocation within 24 months of the treatment.

Conclusions:

Conservative reduction by lever action, involving minimally invasive treatment and little dysfunction, should be considered an optional conservative treatment.     

Spindle cell carcinoma arising at the buccal mucosa: a case report and review of the literature

Aims:

Spindle cell carcinoma (SPCC) is a subtype of squamous cell carcinoma, and it mainly occurs in the upper aerodigestive duct. On the other hand, it rarely arises in the head and neck region. The prognosis of this tumor is usually poor because of its highly malignant behavior, such as its high incidence of recurrence or metastasis to cervical lymph nodes. However, the number of accumulated cases is still too low to provide the full details of SPCC.

Methodology:

The case of SPCC was counted by using database, PubMed. The authors also present a case of SPCC arising at the left buccal mucosa in a 72-year-old Japanese female in the current study.

Results:

Only six cases of SPCC arising at the buccal mucosa have been reported previously. The authors’ patient died from a recurrent tumor 15 months after the first operation.

Conclusion:

The authors have added this case to the previous knowledge of SPCC arising at the buccal mucosa, and discuss the clinical behavior of SPCC to help suggest a standard treatment strategy for the disease.     

Miniscrews for orthodontic anchorage: a review of available systems

Introduction: In recent years, extensive research has introduced novel ways of reinforcing orthodontic anchorage using a variety of devices temporarily anchored in bone (miniscrews). Currently, there are numerous manufacturers with different miniscrew designs on the market.

Aims: The aim of this paper is to discuss the key design features of different miniscrew systems on the market. Furthermore, to present clinical selection criteria of miniscrews in different settings taking into account the determinant factors.

Methods: Review of the literature was carried out using the following search methods: MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). The search was focused on studies published until January 2018.

Results: We studied each individual miniscrew from all the identified manufacturers in details. All the features were then summarised and presented as a clinical guideline for the selection of miniscrews.

Conclusions: In this article, we reviewed the development of miniscrews and outlined the general design features of miniscrews as well as specific design features of the current miniscrews in the market. Extensive research of the current products was carried out to help clinicians better understand the difference between the various designs of miniscrews that can be used.     

Mandibular movement during speech of two related Latin languages

Objectives/hypothesis: This study assessed the kinesiographic recordings of jaw movements during reading a text in Galician and Spanish language.

Study design: Cross-sectional blind study.

Methods: A homogeneous healthy group of 25 normal stomatognathic system and native Galician participants was studied. Frontal and parasagittal plane recordings of the intraborder lateral jaw movements and during reading Galician and Spanish texts were recorded using a calibrated jaw-tracking device, kinesiograph.

Results: Although movements were similar in both languages, a greater retrusion of the jaw in the Spanish language was shown; moreover, a tendency exists for a left-side motion envelope in this right-handedness preference sample.

Conclusions: This study supports the hypothesis that speech is controlled by the central nervous system rather than by peripheral factors and that the hemispheric dominance influences the asymmetry of the speech envelope.     

Occlusal outcomes in combined orthodontic and orthognathic treatment

Objective: To investigate the treatment outcome in terms of the malocclusion features and the changes in the occlusion of patients undergoing orthodontic/orthognathic treatment using the Peer Assessment Rating (PAR) and the Index of Complexity, Outcome and Need (ICON) and to test the application of the Index of Orthognathic Functional Treatment Need (IOFTN) on this sample as a measure of orthognathic pre-treatment need.

Design: Retrospective longitudinal cohort study.

Setting: The orthodontic department at the Eastman Dental Hospital.

Material and methods: The study models of a sample of 100 orthodontic/orthognathic patients who were treated at the Eastman Dental Hospital were measured using the PAR index and ICON at three stages: pre-treatment, pre-surgery and at debond. Treatment need was assessed by measuring IOTN and IOFTN using start study models.

Results: 99% of the sample showed an improvement in PAR score, with 82% of the sample being greatly improved. ICON showed that 95% of the sample had an improvement of different degrees with 5% being not improved or worse. The IOFTN qualified 97% of the patients for orthognathic treatment when used retrospectively on the sample while the DHC of IOTN qualified the whole sample for orthodontic treatment.

Conclusions: Orthodontic/orthognathic treatment showed improved and acceptable overall results. The PAR index and ICON were valid measures to investigate the outcome of orthognathic treatment. IOFTN proved to be a useful tool in determining and prioritizing orthognathic treatment based purely on functional need.     

Inter-arch digital model vs. manual cast measurements: Accuracy and reliability

Objectives: The purpose of this study was to evaluate the accuracy and reliability of inter-arch measurements using digital dental models and conventional dental casts.

Methods: Thirty sets of dental casts with permanent dentition were examined. Manual measurements were done with a digital caliper directly on the dental casts, and digital measurements were made on 3D models by two independent examiners. Intra-class correlation coefficients (ICC), a paired sample t-test or Wilcoxon signed-rank test, and Bland–Altman plots were used to evaluate intra- and inter-examiner error and to determine the accuracy and reliability of the measurements.

Results: The ICC values were generally good for manual and excellent for digital measurements. The Bland–Altman plots of all the measurements showed good agreement between the manual and digital methods and excellent inter-examiner agreement using the digital method.

Conclusion: Inter-arch occlusal measurements on digital models are accurate and reliable and are superior to manual measurements.     

Status of occlusal contact during sleep bruxism in patients who visited dental clinics – A study using a Bruxchecker®

Objective: Bruxism-induced mechanical load causes various dental problems, and its treatment is challenging. The present study analyzed upper and lower tooth contacts to determine actual occlusal contact during sleep bruxism.

Methods: Tooth contact patterns were analyzed in 49 patients attending dental clinics, using a Bruxchecker®, cephalograms, and condylographs.

Results: Approximately 80% of individuals demonstrated contact from the anterior teeth to the molar region (ICPM); about 96% had mediotrusive grinding and contact. The tooth contact area increased with the flatness of the anterior occlusal plane. The ratio of the contact area of the anterior teeth to the overall tooth contact area increased with overbite. Bilateral ICPM and mediotrusive contact patterns were associated with a high frequency of temporomandibular disorder symptoms, clicking, and/or pain.

Discussion: The tooth contact area, anterior occlusal plane, and overbite are closely related, suggesting that tooth contact with the anterior teeth should be controlled with occlusal therapy.     

Expression of CD90 decreases with progression of synovial chondromatosis in the temporomandibular joint

Objectives: The aim of the present study was to investigate the factors that contribute to the progression of synovial chondromatosis in the temporomandibular joint (TMJ).

Methods: The authors investigated the expression of CD105 and CD90 in specimens from 17 patients with synovial chondromatosis in the TMJ, using immunohistochemical staining, and expression of CD105 and CD90 in cartilaginous nodules was scored semiquantitatively.

Results: The expression of CD105 and CD90 was found in almost all the cases. In particular, the expression of CD90 in cartilaginous nodules significantly decreased with the progression of synovial chondromatosis.

Discussion: The factors that determine progression of synovial chondromatosis are not fully understood. The results of this study suggest that CD90 may play an important role in the progression of synovial chondromatosis in the TMJ.     

Rhythm and amplitude of rhythmic masticatory muscle activity during sleep in bruxers – comparison with gum chewing

Objectives: The aim of this study was to elucidate characteristics of rhythmic masticatory muscle activity (RMMA) during sleep by comparing masseteric EMG (electromyogram) activities of RMMA with gum chewing.

Method: The parts of five or more consecutive phasic bursts in RMMA of 23 bruxers were analyzed. Wilcoxon signed-rank test for matched pairs and Spearman’s correlation coefficient by the rank test were used for statistical analysis.

Results: Root mean square value of RMMA phasic burst was smaller than that during gum chewing, but correlates to that of gum chewing. The cycle of RMMA was longer than that of gum chewing due to the longer burst duration of RMMA, and variation in the cycles of RMMA was wider.

Discussion: These findings suggest that the longer but smaller EMG burst in comparison with gum chewing is one of the characteristics of RMMA. The relation between size of RMMA phasic bursts and gum chewing is also suggested.     

Chondroblastoma of the temporomandibular joint lateral capsule: a case report

Aim: Chondroblastoma is a rare, benign bone tumor that accounts for approximately 1% of all primary bone tumors. Chondroblastoma that occurs at the temporomandibular joint can exhibit symptoms similar to those associated with other temporomandibular disorders. This case study aims to present an eight-year followup of chondroblastoma occurring at the temporomandibular joint.

Methodology: The patient presented swelling in the left temporomandibular joint and trismus. Based oncomputed tomography and magnetic resonance imaging findings, a provisional diagnosis of synovial chondromatosis was made. Complete excision of the lesion was performed under general anesthesia.

Results: After histopathological examination, the lesion was finally diagnosed as chondroblastoma. Currently, 8 years after the operation, the patient has not experienced any symptoms or any notable complications.

Conclusions: Although chondroblastoma is a benign tumor, it shows aggressive characteristics with bone invasion. Therefore, precise diagnosis and proper treatment planning is crucial for successful treatment of chondroblastoma.     

Patient’s expectations of lingual orthodontic treatment: a qualitative study

Objective: To investigate patients' expectations of lingual orthodontic treatment.

Design: In-depth interviews were conducted. A framework analysis was carried out to identify themes, concepts and a typology.

Setting: Two secondary care hospital departments and four primary care orthodontic practices, UK.

Materials and methods: Fifteen new orthodontic patients aged 16–60 years participated in the interviews. All interviews were transcribed verbatim and analysed using framework analysis, including identification of themes within the responses, and typologies of respondents.

Results: Patients seeking lingual orthodontics reported expectations that were similar in quality but different in extent to those seeking labial orthodontics. These patients were well informed about lingual orthodontic treatment before they decide to start treatment. Two typologies were identified. Firstly, males less than 30 years of age, undergoing changes in their lives, who were confident that they wanted a hidden brace, but were not entirely sure of the specifics of the system. Secondly, females aged 30–45, who request a hidden brace and had actively researched what particular systems were available. Conclusions: This study shows that patients requesting lingual orthodontics have expectations that are similar in quality but greater in extent when compared to those seeking labial orthodontics.     

Quantitative measurements of the articular areas of mandibular condyles with temporomandibular joint disorders using magnetic resonance imaging

Objective: The authors sought to clarify the variation in the condylar anterior functional surface (AFS) of patients with temporomandibular joint (TMJ) disorders using quantitative measurements by magnetic resonance imaging (MRI).

Methods:MR images of 68 joints (2 males, 32 females) were used. The subjects were classified into three groups: with/without defects of cortical bone groups and a combination group without defects. The AFS was measured as the length between the protrusive point and the apex of the condyle on MRI (4-mm-thick slices), and the quad value of the length was defined as the area on the slice. The summed quad values of all slices were used as the AFS area. Differences in the areas among the three groups were compared by one-way analysis of variance (ANOVA).

Results:The non-defect group had significantly larger AFS areas than the defect group.

Conclusions:Quantitative measurement on MR images clarified the changes in the condylar sagittal appearance.     

Efficiency and effectiveness of orthodontic treatment within United Kingdom secondary care: a service evaluation

Objectives: To evaluate the efficiency and effectiveness of Orthodontic treatment in the National Health Service (NHS) hospitals in England and to identify factors that may be predictive of the duration of Orthodontic treatment and number of patients’ visits.

Design: Retrospective service evaluation.

Setting: The orthodontic departments of two NHS hospitals.

Methods: The data were collected from the clinical notes, the hospital data base and the pre- and post-treatment study models of 70 patients who were treated with fixed appliances. The pre- and post-treatment models were assessed using the Index of Orthodontic Treatment Need (IOTN) and the Peer Assessment Rating (PAR) index.

Results: (1) 98.5% of the patients treated with fixed appliances in both hospitals were in definite need for treatment, (2) The mean percentage PAR score reduction was 81.5%, (3) The mean treatment duration was 27 months with an average of 21 appointments, (4) Factors increasing treatment duration included being a female patient, class I malocclusion, IOTN 5, extractions, prescribing headgear wear, using functional appliances or quadhelixes and increased number of missed appointments, (5) Factors reducing the treatment time were male patients, class II or class III malocclusions and an increased number of emergency appointments.

Conclusions: The hospitals demonstrated a high standard of orthodontic treatment.     

Clinician accuracy when subjectively interpreting articulating paper markings

Aims:

The aim of this study was to determine whether Subjective Interpretation of paper markings is a reliable method for identifying the relative occlusal force content of tooth contacts.

Methodology:

295 clinicians selected the “Most Forceful” and “Least Forceful” occlusal contacts in six occlusal-view photographs of articulating paper marks that were later compared against computerized occlusal analysis relative occlusal force measurements of the same tooth contacts. Means and standard deviations were calculated by years in clinical practice and by number of occlusion courses taken. A Chi-square analysis was also performed.

Results:

The mean correct for 295 participant dentists was 1·53 (±1·234). There were no significant differences found for years in practice (P>0·16) or number of occlusion courses taken (P>0·75). The Chi-square analysis showed a sensitivity of 12·6%, a specificity of 12·4%, a positive predictive value of 12·58%, and a negative predictive value of 12·42%. Chance was calculated at 12·5% correct.

Conclusions:

Subjective Interpretation is an ineffective clinical method for determining the relative occlusal force content of tooth contacts. The reported low scores obtained from a large group of participant dentists suggest clinicians are unable to reliably differentiate high and low occlusal force from looking at articulating paper marks. This longstanding method of visually observing articulating paper marks for occlusal contact force content should be replaced with a measurement-based, objective method.     

Morphological changes in the temporomandibular joint after orthodontic treatment for Angle Class II malocclusion

Objective: The aim of this study was to examine the morphological temporomandibular joint (TMJ) changes that occur after orthodontic treatment in patients with Angle Class II malocclusion.

Methods: The post-treatment changes in TMJ morphology were analyzed, based on TMJ cephalometric laminographs in 19 patients with Angle Class II malocclusion and labial inclination of the upper incisors after premolar extraction.

Results: The condylar pass angle, articular eminence to the Frankfort horizontal plane angle, and total, upper, and lower heights of the articular fossa increased significantly on both sides after treatment and retention. The anteroposterior width of the articular fossa decreased significantly on both sides after treatment and retention.

Discussion: These results suggest that adaptive bone remodeling of the TMJ occurs during the correction of occlusion with labial inclination of the upper incisors by orthodontic treatment after premolar extraction in patients with Angle Class II malocclusion.     

Could different TMJ disc positions observed in MRI cause different sounds? Analysis on a group of subjects with ADD with reduction: a pilot study

Aims:

Magnetic resonance imaging (MRI) is the method of choice for examining soft-tissue pathology of the temporomandibular joint (TMJ). MRI shows a high spatial resolution with accuracy for the identification of internal derangement. Tasaki developed a classification system for disc displacement in the TMJ, identifying eight different types of disc displacements in addition to the superior disc position. This study aims to test the ability of electrosonography (ESG) in discriminating different kinds of disc displacement according to the disc position criteria proposed, comparing the ESG results with those obtained by MRI.

Methodology:

Twenty-seven patients were selected from an initial group of 50 patients with articular disc displacement, selected by means of clinical examinations, according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and who had both MRI and ESG studies performed. For each patient and for each peak in ESG, both in the opening and closing movements, three different parts of the sound were analyzed. The frequency (Hz) and the mean amplitude (μV) of the sounds were calculated in the three analyzed windows. Afterwards, gathering the data for the Tasaki’s classes and dividing opening and closing sounds, the number of peaks was calculated, as well as average and standard deviations for both the Hz and µV.

Results:

The peak frequency shows significant differences between different disc positions during the first and second third of the opening phase and during the first third of the closing phase. The peak amplitude shows significant differences between different disc positions during all of the opening and closing phases.

Conclusions:

Although limited by sample size, the present study shows the presence of different sounds with different Hzs and μVs associated with different disc positions that were recorded with ESG.