Are specialist outreach clinics for orthodontic consultation effective? A randomised controlled trial

OBJECTIVE: To develop outreach clinics for orthodontic consultation and evaluate their costs and effectiveness. DESIGN: Single centre randomised controlled trial with random allocation of referred patients to outreach or main base consultation appointments. SETTING: One hospital orthodontic department and three community health centre clinics in Greater Manchester. Subjects 324 patients who were referred for orthodontic treatment. MAIN OUTCOME MEASURES: The outcome of consultation, the cost and duration of the visit and the consumer's perceptions of the visit. RESULTS: There were no differences in outcome of the consultation. While consumer travel costs and the duration of appointments were significantly higher for the main base clinics, these differences were not great. However, consumers preferred to attend an appointment in an outreach clinic. CONCLUSIONS: There do not appear to be marked advantages or disadvantages in providing consultation appointments for orthodontics in outreach clinics     

Chewing gum vs. ibuprofen in the management of orthodontic pain,a multi-centre randomised controlled trial – the effect of anxiety

Objectives: Pain is a common side effect of orthodontic treatment. An objective of this study, part of a large previously reported RCT on pain and analgesic use, was to determine the effect of anxiety on perceived pain and use of analgesia.

Methods: 1000 patients aged 11–17 years, undergoing upper and lower fixed appliance treatment in nine hospital departments were recruited into this two-arm parallel design randomised controlled trial. One arm was given sugar-free chewing gum and the other arm ibuprofen for pain relief. Neither the clinicians nor patients were blinded to assignment. In addition to recording pain experience and analgesic use for 3 days following appliance placement and first archwire change, each patient recorded their level of anxiety immediately following the fitting of the appliance and the first archwire change.

Results: 419 chewing gum group (84%) and 407 ibuprofen group (83%) questionnaires were returned following appliance placement, and 343 chewing gum group (70%) and 341 ibuprofen group (71%) questionnaires were returned following the first archwire change. The mean anxiety scores following fitting of the appliance and first archwire change were 2.7 (SD 2.1) and 1.6 (SD 1.8), respectively. There were weak but significant positive associations between anxiety scores and pain scores. Multi-level modelling produced a coefficient for anxiety of 0.23 (95% CI 0.17–0.28) for appliance placement, suggesting a small rise (0.23) on the 11-point pain scale for a one-point increase on the corresponding anxiety scale. Following archwire change, the corresponding coefficient was 0.32 (0.24–0.39). For ibuprofen use, again simple analyses suggested a relationship with anxiety. Multi-level logistic modelling produced an odds ratio for ibuprofen use of 1.11 (95% CI 1.07–1.15) at appliance placement and 1.21 (1.10–1.33) at the first archwire change. There was a 10–20% increase in the odds of using ibuprofen for each one-point increase on the anxiety scale. No such relationship was found between anxiety and chewing gum use. There were no adverse effects or harms reported during the trial. Approvals were granted by the Research Ethics Committee (08/H0106/139), R&D and MHRA (Eudract 2008-005522-36) and the trial was registered on the ISRCTN (79884739) and NIHR (6631) portfolios. Support was provided by the British Orthodontic Society Foundation.

Conclusions: There was a weak positive correlation between anxiety reported and pain experienced following both the initial fitting of the fixed appliances and at the subsequent archwire change. Patients that were more anxious tended to take more ibuprofen for their pain relief.     

Radiotherapy-induced xerostomia: a randomised,double-blind,controlled trial of Visco-ease™ oral spray compared with placebo in patients with cancer of the head and neck

Radiotherapy-induced xerostomia (RIX) is a common and untreatable side effect of radiotherapy to the head and neck. Visco-ease? mouth spray (Lamellar Biomedical Ltd), a new product that is made from lamellar body mimetics, reduces the viscosity of saliva ex vivo. The purpose of this study was to evaluate its safety and effectiveness in the treatment of RIX in 43 patients with cancer of the head and neck. They were randomised into the Visco-ease? or placebo groups, and asked to complete the Groningen radiotherapy-induced xerostomia (GRIX) questionnaire each week. The primary endpoint was a change in GRIX score from baseline to end of treatment. There was no difference in scores between the two groups, and none of the patients had device-related serious adverse events. Visco-ease? oral spray was safe and tolerable but no better than placebo in reducing RIX in this group of patients.     

Do patient information leaflets affect patients' expectation of orthodontic treatment? A randomized controlled trial

Aim: To determine the impact that information leaflets have on patient expectations of orthodontic treatment. Design: A prospective, randomized controlled study. Setting: The Orthodontic Department at Queen Mary's Sidcup, South London Healthcare NHS Trust. Participants: Eighty adolescents, aged 12-14 years,attending their first orthodontic consultation appointment. Intervention: Participants completed a previously validated questionnaire about their expectations of orthodontic before the consultation.They were then randomly assigned to two groups. The control group (n?=?40)received additional written information about fluoride, while the intervention group (n?=?40) received additional written information about orthodontic treatment. Both groups then had their orthodontic consultation following which they completed the expectation questionnaire for a second time. Outcomes: The questionnaire consisted of 10 questions.Eight questions used a 10 mm VAS response code. Two questions had categorical response codes. ANCOVA was undertaken using post-consultation scores as the outcome and pre-consultation scores as the covariant. Chi-squared tests were undertaken to assess the categorical variables. Results: All 80 participants recruited to the trial completed the questionnaire on two occasions. No significant differences between the control group and the intervention in their expectations of orthodontic treatment were found, except for one item related to the expectation of a discussion about treatment at the initial appointment (P?=?0·04). Conclusion: Information leaflets did not have an immediate impact on patients' expectations of orthodontic treatment. The cost implication of providing information leaflets to patients must be weighed against the limited benefit they provide.     

Do educational methods affect students' ability to remove artificial carious dentine? A randomised controlled trial

This trial aimed to evaluate the influence of two educational methods on students' ability to remove artificial carious dentine. Traditional lecture and lecture plus a live demonstration of artificial carious tissue removal were compared in a blind two‐parallel‐group design. Twenty‐six students were randomly divided into two groups, and their skills were evaluated according to the following criteria: time spent on the dentine excavation procedure (in min), students' perceived confidence in conducting the procedure (graded assessed on a scale from 0 to 10), and the outcome of artificial carious tissue removal, evaluated by measuring the residual dyed artificial carious dentine layer (in μm). Statistical analyses were carried out using a t‐test to compare the students' confidence and time spent on the procedure, and a two‐way ANOVA was used to compare residual artificial decayed dentine with educational methods and tooth region (incisal, medium, and cervical thirds) as factors. There were no differences between the methods regarding excavation time (P = 0.898) and students' confidence (P = 0.382). The residual artificial carious dentine results showed that the educational method (P < 0.001) and cavity region (P < 0.001) were statistically significant, as was their interaction (P = 0.040). The lecture plus live demonstration group presented the best results for artificial caries removal. Although there were no differences between the two groups for the cervical region, the best results for the lecture plus live demonstration group was in the other two‐thirds of the tooth.     

Effectiveness of Clinpro Tooth Crème in comparison with MI Varnish with RECALDENT™ for treatment of white spot lesions: a randomized controlled trial

Background

Unsightly opaque white impaired enamel may ruin a great aesthetic orthodontic outcome. This study aims to evaluate effectiveness of Clinpro Tooth Crème (0.21% w/w NaF anti-caries dentifrice with 950 ppm fluoride and f-TCP) and MI Varnish with RECALDENT™ (CPP-ACP) for treatment of white spot lesions (WSLs).

Materials and methods

This was a randomized (1:1:1), single-blind, 3-armed, active-controlled, parallel-group trial. The study comprised three groups of 35 patients randomly assigned in blocks of 3 or 6 to one of the three following arms of the study-

Group I: Clinpro™ Tooth Crème 0.21% Sodium Fluoride Anti-Cavity Paste with functional–Tri Calcium Phosphate(f-TCP) group.

Group II: Fluoride varnish group (MI Varnish with RECALDENT™).

Group III: Home-care group (control).

For the subjective assessment, a blinded panel of 4 dental experts rated the improvement in WSLs over the eight weeks using a visual analog scale (VAS).

Results

In total, 240 WSLs were identified, with maxillary lateral incisors and canines showing the highest incidence. Group I achieved the highest success rate of 67.61 (%) followed by group II (60.59%). There were no significant differences between the success rates of treatment in groups I and II. A minimum decline in WSLs was found in the control group, with a success rate of only 32.43%, significantly less than the first two groups (P < .001).

Conclusion

Both the test agents in consideration were comparable in their remineralization potential. Clinpro Tooth Crème provides additional protection against decalcification of enamel compared to MI Varnish with RECALDENT™ (CPP-ACP).

Trial/project registration no. and date

4857/2017 on 21 June 2017.

     

Use of the MatrixWAVE™ system with dentures to establish maxillomandibular fixation in edentulous patients

Various methods have been described to establish maxillomandibular fixation in the treatment of fractures of atrophic, edentulous mandibles. We used the Synthes MatrixWAVE? system (DePuy Synthes) in combination with dentures in two patients with fractured, edentulous, atrophic mandibles. Fixation was maintained for fractures that were not amenable to, or did not require, open reduction and internal fixation, and the mandibles were both well-healed and had good function at the end of treatment.     

Can psychological models bridge the gap between clinical guidelines and clinicians' behaviour? A randomised controlled trial of an intervention to influence dentists' intention to implement evidence-based practice

OBJECTIVE: The lag between publication of evidence for clinical practice and implementation by clinicians may be decades. Research using psychological models demonstrates that changing intention is very important in changing behaviour. This study examined an intervention (rehearsing alternative actions) to change dentists' intention to implement evidence-based practice (EBP) for third molar (TM) management. DESIGN: Randomised controlled trial / postal. SETTING: Primary care. SUBJECTS AND METHODS: Dentists were randomly selected from the Scottish Dental Practice Board Register, then randomly allocated to intervention or control groups, and sent a questionnaire. The intervention group listed management alternatives to TM extraction prior to their TM extraction intention, and the control group did not. Based on psychological models for reducing a behaviour's frequency (EBP is weighted against TM extraction), prior listing of alternatives should decrease extraction intention. MAIN OUTCOME MEASURES: Intention to extract TMs. RESULTS: A total of 99 dentists - 70 Males, 29 Females; mean age = 41.42 years (SD = 8.62) participated in the study. The intervention significantly influenced intention to extract TMs, as desired. Despite similar background and knowledge of management alternatives, participants in the intervention group had significantly lower intention to extract: control group mean (SD) = 0.39 (1.99); intervention group mean (SD) = -0.78 (1.89); mean difference (SE) = 1.17 (0.42); 95% confidence interval for the difference = 0.34 to 1.99. CONCLUSION: Results suggest this intervention, which successfully influenced a proximal predictor of behaviour pertinent to dental EBP, may result in improved EBP in a service-level trial. Basing implementation interventions and trial methodology on psychological models may effectively bridge the gap between clinical guidelines and practice.     

Immediate Non-functional Loading of Single Tooth Uniti™ Implants into Avulsed Tooth Sockets Following Ridge Augmentation in the Anterior Maxilla: A Case Series

To assess the clinical effectiveness of immediate non-functional loading of single-tooth implant placed into avulsed tooth socket following ridge augmentation in the anterior maxilla with bioglass bone substitute and biocollagen membrane. The clinical outcome of immediate non-functional loaded implants up to 24 months after placement into avulsed tooth sockets in anterior maxilla were evaluated in 15 patients. Implants were immediately restored with acrylic resin provisional crowns. Post-operative follow-up and intraoral radiographs were obtained at 6, 12, 18 and 24 months. Survival rate, implant threads exposure immediately after placement and at 6 month interval using CT 3D reconstruction was assessed. Marginal bone loss did not extend beyond the first thread and 3D CT scan showed adequate bone mineral density with no signs of radiolucent lesion around the implant during 24 months follow-up having survival rate of 100 %. Within the limits of the present study, immediate non-functional loading of single tooth implant placed into avulsed tooth socket following augmentation with bioglass bone substitute and biocollagen membrane in the anterior maxilla is one of the viable treatment alternatives for rehabilitation of immediate loading implant.     

Is it worth applying self-irrigation after third molar extraction? A randomised controlled trial

In this study, we aimed to examine the effectiveness of self-irrigation following the extraction of mandibular third molars. A randomised controlled clinical trial was conducted with 155 patients who had undergone extraction of a mandibular third molar. The irrigation group was instructed to self-irrigate the extraction socket with tap water using a syringe three times a day, starting seven days after the tooth extraction. The incidence of complications and mouth opening, halitosis, plaque/gingival index, and oral health-related quality of life (OHRQoL) were measured. The irrigation group showed a lower incidence of complications than the non-irrigation group. The halitosis, plaque, and gingival scores were lower by mean (SD) 19.66 (5.19), 0.58 (0.06), and 0.62 (0.08), respectively, in the irrigation group than in the non-irrigation group (p = 0.0001). A greater amount of food packing was associated with higher halitosis, plaque, and gingival scores and poorer OHRQoL (p < 0.05). Further, more frequent irrigation was associated with lower halitosis, plaque, and gingival scores and better OHRQoL (p ≤ 0.016). Self-irrigation of the extraction socket using a syringe containing tap water is a very effective method for keeping the extraction socket clean. This technique reduced halitosis, improved plaque and gingival indices, and increased OHRQoL.     

Evaluation of prolotherapy in comparison with occlusal splints in treating internal derangement of the temporomandibular joint – A randomized controlled trial

PurposeThe aim of this study was to compare the efficacy of dextrose prolotherapy with that of occlusal splints in treating internal derangement of the temporomandibular joint.Patients and methodsA total of 34 patients with temporomandibular joint internal derangement classed as Wilkes stages II or III were recruited for the study, and were randomly divided into study and control groups with 17 patients each. The patients in these control and study groups were treated with splints and prolotherapy, respectively. Outcome parameters, such as pain, mouth opening, clicking and deviation, were assessed using the Helkimo clinical dysfunction index for a review period of 1 year.ResultsNine patients in the study group had complete absence of pain, compared with only one patient in the control group. The results showed that patients who received prolotherapy demonstrated improvement in pain (p < 0.001), mouth opening (p = 0.032), and clicking (p < 0.001), but no significant difference in deviation was observed between the groups after 1 year (p = 0.862).ConclusionProlotherapy was found to be superior in providing long-term clinical relief, with reduction in pain and clicking along with improved mouth opening.     

Evaluating the effect of Clinpro Tooth Crème on remineralization of pre-carious White Spot Lesions in anterior primary teeth: Randomized controlled clinical trial

BackgroundNew direction in dentistry has been developed to increase the minimal-invasive approach, especially in younger children. Therefore, needs has arise to find new techniques to replace the restorative and surgical treatments of dental caries with more conservative therapies. So that remineralization therapies has taken place in the last few years.Materials and methodsA total of 84 teeth with white-spot lesions in 18, three-to-five-year-old children were included in the study. All of the selected teeth had no yellow or brown discoloration, no carious cavities or developmental defects, and gave the value of 5–17 when measured using DIAGNOdent.Clinpro Tooth Crème was applied for 3 min after cleaning and drying on each tooth, a photograph was taken after every application with intervals of one week, two weeks, four weeks and six weeks. The laser fluorescence intensity was measured using DIAGNOdent before every application and 10 min after. The clinical appearance change was evaluated by calculating the ratio of the area of white-spot lesion to the whole area of buccal surface of each tooth using AutoCAD 2015. Results were statistically analyzed using Mann-Whitney and Kruskal-Wallis tests.ResultsStatistical analysis showed that there was an important significant differences between DIAGNOdent values of Clinpro group and the other group (p < 0.05), but no significant change in the ratio of the area of white-spot lesion to the whole area of buccal surface of the tooth (p > 0.05).ConclusionsClinpro Tooth Crème improved white-spot lesions remineralization but did not prettify clinical appearance after its application within the used protocol.