Treatment management between orthodontists and general practitioners performing clear aligner therapy

Objective:To investigate differences in case selection, treatment management, and aligner treatment expertise between orthodontists and general practitioners.Materials and Methods:A parallel pair of original surveys with three sections (case selection, treatment management, and demographics) was sent to orthodontists (N = 1000) and general dentists (N = 1000) who were providers of aligner treatment.Results:Orthodontists had treated significantly more patients with aligners, had treated more patients with aligners in the previous 12 months, and had received more aligner training than general dentists (P < .0001). In general, case confidence increased with increasing experience for both orthodontists and general dentists. After adjusting for experience, there was a significant difference in aligner case confidence between orthodontists and general dentists for several malocclusions. General dentists were more confident than orthodontists in treating deep bite, severe crowding, and Class II malocclusions with aligners (P ≤ .0001). Significant differences were also found for all treatment management techniques except interproximal reduction.Conclusion:There was a significant difference in case selection, treatment management, and aligner expertise between orthodontists and general dentists, although the differences in case selection were small. Overall, it was shown that orthodontists and general dentists elected to treat a variety of moderate to severe malocclusions with aligners but with different utilization of recommended auxiliaries, perhaps demonstrating a difference in treatment goals.     

Biomechanics in lingual orthodontics: What the future holds

The field of orthodontics faced a few fundamental pivots since 1800. Edward Angle introduced a systematic approach to treating patients in 1899. Between 1920 and 2000, development of new orthodontic appliances as well as improvements in orthodontics education reshaped orthodontics. Digital technology has changed how orthodontists treat malocclusions in the last two decades. Specifically, advances in digital orthodontics introduced a paradigm shift in lingual orthodontics attracting more orthodontists especially recently graduated practitioners to offer lingual appliances. This review aimed to point out some of important biomechanical factors in lingual orthodontics and to delineate commonalities and contrasts of these factors in clear aligners and labial systems. Highlights of two work in-progress lingual systems were also discussed. One can reason that better understanding of the advantages and challenges associated with lingual systems especially in comparison to clear aligners and labial systems is essential to creating a fully customized orthodontic experience for patients.     

国产无托槽隐形矫治技术的临床应用初探

目的 将我国自主研发的无托槽隐形矫治技术应用于口腔正畸临床,探讨该矫治器的临床应用情况、存在的问题以及应用前景.方法 选取41例较简单的错(牙合)畸形患者,主要包括牙列间隙、牙列拥挤以及牙周病止畸治疗,应用国产无托槽隐形矫治技术进行正畸治疗.通过层析扫描建立数字化三维牙颌模型,通过激光快速成形技术加工无托槽隐形矫治器,根据治疗方案,为每例患者设计10～40副矫治器.患者每2～3周更换一副矫治器,矫治后评估疗效.结果 所有病例均完成矫治并取得良好的矫治效果,矫治后牙列排齐、无间隙、前牙覆(牙合)覆盖正常,矫治疗程6～25个月,平均18个月.结论 目前,国产无托槽隐形矫治技术仅町矫治相对简单的错(牙合)畸形,并以其透明、美观、舒适、卫生等优点,而具有良好的临床应用前景.     

Angle classification revisited. 1: Is current use reliable?

The Angle method for the classification of malocclusion has been the standard in orthodontics for 100 years, but many academics and private practitioners find difficulty applying the Angle system to malocclusions in between fully Class II and fully Class III. To evaluate whether orthodontists are consistent in classifying malocclusions accordings to Angle's method, study models were selected of three patients with ideal buccal occlusions, two patients with mutilated occlusions, and five patients with varying degrees of Class II tendency. One buccal view was photographed of each study model, and a questionnaire was printed and sent to 347 orthodontists. The 77.8% response demonstrated significant interest in the subject of dental classification and significant disagreement among orthodontists in their classification response with all patients except the two obvious ideal occlusions. Respondents were given the opportunity to comment on Angle classification and their recommendations for improved classification techniques. Many of their comments are quoted.     

Early Orthodontic Treatment of Class-III Malocclusion in Germany

In order to evaluate current attitudes to early interceptive treatment, 2001 orthodontic offices in Germany were asked to fill in a questionnaire comprising the following topics: indication, appliances for the early correction of Class-III malocclusions, diagnostic records, duration, and benefits to overall therapy. Based on the 677 evaluable questionnaires, the following statistically significant conclusions could be drawn: 92.6% of the orthodontists see Class-III malocclusion as an indication for early treatment. Early treatment of severe crowding, diastemata, Class-II malocclusion, deep bite, increased overjet and impacted incisors was declined by most orthodontists. The interceptive treatment of further malocclusions was controversially discussed. Functional appliances (67.5%), in particular the Fr?nkel III (47.3%), were dominant in correction of Class-III malocclusions. Typical orthodontic records relating to early interceptive treatment include panoramic radiographs, lateral headfilms, photos and dental casts. 2.5% of the orthodontists routinely take a hand-wrist radiograph. Although recently published studies support the use of facial masks in theory, they are rarely used in practice. To what extent early interceptive treatment of Class-III malocclusion influences the overall treatment is the subject of further studies.     

Use of clear aligners in open bite cases: an unexpected treatment option

In open bite case treatments, a proper diagnostic differentiation is essential in determining the appropriate corrective procedures. Dental open bites are generally more responsive to treatment with orthodontics alone, whereas skeletal open bites often require a combination of orthodontics and orthognathic surgery. Patient selection and treatment principles for non-surgical open bite treatment routinely include fixed appliances both labial or lingual. However, removable clear aligners have gained a consistent popularity in the treatment of complex cases including open bite malocclusions. In this article, the authors describe three different clinical cases in which open bite cases had been satisfactorily treated by using clear aligners.     

Children's perceptions of their own malocclusions

Recognition by a parent or child of an occlusal abnormality is one of the many factors which may influence a desire for orthodontic treatment. Non-orthodontists may not estimate the severity of malocclusion reliably and may use different criteria from orthodontists for the process. The present study therefore sought to examine the reliability of parents' and children's perceptions of the children's own malocclusions with rating scales under two anchoring conditions and to test the discrepancy between their estimates and those of a panel of orthodontists. The children's and parents' assessments had limited test-retest reliability but instead of making guesses about the severity of their malocclusions they consistently gave low estimates. These effects were not influenced by the additional anchoring stimuli.     

Orthodontic bone screws: A quick update and its promising future

Orthodontic bone screws (OBSs) provide intraoral anchorage by penetrating oral mucosa and seating firmly in basilar bone (BB). Retromolar (prosthetic-type) implants introduced the extra-alveolar (E-A) concept for BB anchorage to move teeth throughout the alveolar process, but the clinical procedures were complex and expensive. Titanium alloy (Ti) miniscrews placed in inter-radicular (I-R) alveolar bone are more convenient and provide some tooth movement potential, but multiple screws are usually required and the devices often interfere with the path of tooth movement. The advantages of BB anchorage and the convenience of miniscrew are combined into the E-A OBS system. These miniscrews are relatively large in diameter (2 mm), and strong (stainless steel), which are placed intraorally in the BB of the infra-zygomatic crest (IZC) and mandibular buccal shelf (MBS). E-A OBSs provide osseous anchorage to retract the dentition and/or rotate either arch. Recovery of impactions is effectively managed with lever arm springs anchored with IZC or MBS bone screws. An emerging frontier is BB anchorage for correcting severe malocclusions with clear aligners. Since the osseous-anchored mechanics are complementary, fixed appliances and clear aligners can be used individually or in tandem to resolve a broad variety of malocclusions. This report summarizes current concepts for conservatively managing complex malocclusions such as severe crowding, skeletal discrepancies, asymmetries and impactions with the OBS system.     

Direct-to-consumer orthodontics: surveying the user experience

BackgroundThe rise of direct-to-consumer (DTC) orthodontics has caused significant controversy among dentists and orthodontists. However, little is known about the actual harms or benefits experienced by users of at-home teeth aligners.MethodsThe authors designed a 24-item online survey to assess users’ experiences with at-home aligners. The authors recruited users for 6 months (March-August 2019) on social media platforms (Instagram, Twitter) and online forums related to DTC orthodontics. A total of 470 responses were analyzed.ResultsThe typical respondent was a white, female millennial (23-38 years old in 2019) who purchased aligners to correct crowding. More than one-half of respondents consulted with a dentist before purchasing aligners. In those interactions, the dentist most often recommended an in-office treatment. Although most respondents (87.5%) were satisfied with DTC treatment, 6.6% had to visit their dentist due to the severity of adverse effects.ConclusionsAlthough many respondents would have preferred traditional treatment from a dentist or orthodontist, they opted for DTC aligners because of cost and convenience.Practical ImplicationsRather than warning patients wholesale against at-home aligners, it might be more productive for dentists to have frank discussions with them about the risks and benefits. In parallel to pushing for increased accountability, it might be prudent to consider new ways of coexisting in this altered landscape, such as offering professional oversight of DTC treatments.     

Prevention and treatment after age 10 with the edgewise technique

The success of therapy for Class II malocclusions depends on the choice orthodontists make on when to intervene. Usually they begin a two-stage treatment, first orthopedic, then orthodontic, in the mixed dentition. If they want to their non-extraction therapy to coincide with and benefit from growth, they need to diagnose the malocclusion as early as possible. Treatment of Class II malocclusions works best when it is undertaken before the second molars erupt. By correcting the malrelationship between the jaws with an orthopedic appliance, they facilitate the second, full-banded stage of treatment.     

无托槽隐形矫治器推上颌磨牙远移的效率及影响因素研究进展

无托槽隐形矫治器在推上颌磨牙远中移动方面具有显著优势。但由于上颌解剖结构不同及患者依从性差异等因素,上颌磨牙远中移动的实际移动量与设计移动量间存在一定差异,影响最终矫治效果。该文就患者基本情况、上颌磨牙及周围解剖结构、方案设计方面进行综述,以期为正畸医生设计上颌磨牙远移方案提供参考依据,并提高远移实现效率。     

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第二磨牙的错在临床上十分常见,给临床矫治带来不少麻烦。从本质上讲,第二磨牙错是拥挤的表现,主要在磨牙区。临床上表现为单个牙或几个牙出现正锁或反锁,牙齿的颊移位或舌移位,垂直阻生或近中阻生致无法正常萌出等。本文讨论了第二磨牙错的发生原因及危害,介绍了临床上第二磨牙错矫治的原则及主要方法。     

Efficacia e vantaggi di una metodica invisibile a rivalutazione sequenziale: il sistema Clear Aligner

Objectives

To describe indications, manufacturing methods, and use of Clear Aligner in comparison with other types of transparent masks, and the underlying advantages and disadvantages of each methodology.

Materials and methods

A review of the available literature on the web and in the PubMed database was carried out. Several aligners available on the market were taken into consideration, with particular interest for the Clear Aligner method.

Results

Although all aligners appear to be similar in their way of working and the kind of malocclusions they can resolve, Clear Aligner approaches therapy with a different philosophy. The most popular aligners need a virtual treatment planning that cannot be modified once the therapy is started. Instead, Clear Aligner allows instad the orthodontist to progressively adapt the treatment to situations that may occur during the treatment.

Conclusions

Among all the available aligners, Clear Aligner guarantees excellent aesthetics, comfort, and progressive reevaluation. The orthodontist can modify the treatment at any time, adapting it to the specific problems of every single patient.     

Control of vertical dimension in Root's technique. Part 1. Class I and Class III

Does a technique using pre-adjusted brackets offer orthodontists advantages or stumbling blocks in their efforts to improve control of vertical dimension over the course of full-banded treatment? If pre-adjusted brackets are always helpful in hyper-divergent cases, how can orthodontists utilize them to the fullest extent? The author attempts to respond to these questions in a two-part article. The first section deals with the specific cephalometric and mechanical characteristics of hyper-divergent skeletal Class I and Class III cases by analyzing two clinical examples: the objective being to control the hyper-divergence. The second part is devoted to skeletal Class II malocclusions in which the hyper-divergence must be reduced in order to stimulate optimal anterior rotation of the mandible.     

Orthodontists' views on indications for and timing of orthodontic treatment in Finnish public oral health care

The aim of this study was to analyse the variation in the views of Finnish orthodontists on the indications for orthodontic treatment, timing of orthodontic assessment, and treatment methods used. The views were elicited by a questionnaire that was sent to all 146 specialist orthodontists under 65 years of age living in Finland in 2001. The response rate was 57 per cent. The association between an orthodontist's experience and timing of treatment was tested by Fisher's exact test. Stepwise logistic regression analysis was used to estimate the association between the demographic characteristics of orthodontists and the tendency to start Class II division I treatment early. Most orthodontists recommended that the first assessment of occlusion should be carried out before 7 years of age. A crossbite was mentioned as the most frequent indication for treatment in the primary and early mixed dentition, and a severe Class II division I malocclusion with an increased overjet as the most frequent indication in the late mixed dentition. Most respondents preferred early treatment, but there was a wide variation in the choice of appliances and in the timing of treatment of malocclusions other than crossbite and Class II malocclusions. A quadhelix, headgear, and the eruption guidance appliance were the most frequently used appliances in early treatment, with fixed appliances being most frequently used during the late mixed and permanent dentition phase. Orthodontists working full time in municipal health centres tended to prefer early treatment more often than those working part-time or outside health centres. There was no statistically significant association between an orthodontist's experience and timing of Class II division I and Class III treatment (P = 0.142 and P = 0.296, respectively). The preference for an early start in Class II division I treatment might be related to differing professional decisions, but no explaining factors could be found in the regression analysis.     

Principi di base e applicazioni cliniche del sistema Invisalign

Objectives

To describe the Invisalign system that allows an esthetical orthodontic treatment in adult patients with malocclusions where pure tooth movement is required by orthodontic clear aligners. These appliances cover the whole teeth surface, unlike traditional orthodontic brackets and wires.

Materials and methods

The innovation of this system is the virtual displaying of orthodontic tooth movement with a CAD system and the manufacturing of clear aligners (CAM stage) using the newest technologies. Study analyses are always needed to allow the orthodontist to devise the first virtual treatment plan followed by a critical evaluation before the selection of the final result.

Results

Two cases with dentoalveolar problems in permanent dentition are reported with pre- and post-treatment records. A case of combined treatment with esthetical brackets and Invisalign is also reported. Finally, the author shows records of a case at the beginning, before finishing, and two years after treatment.

Conclusions

The type of malocclusion and patient selection are the most important factors for a successful treatment with the Invisalign system, because patients must comply in wearing aligners day and night.     

基于牙弓形态大小发育的青少年隐形矫治

青少年牙弓形态大小的发育具有特定的规律，正常的牙弓形态大小是正常咬合发育的基础之一。全面深入地分析颅颌面的形态和结构，可完善青少年错牙合畸形的临床矫治方案。文章就牙弓形态大小对咬合关系影响的临床理论在错牙合畸形矫治中的应用，探讨青少年隐形矫治技术的特点，总结其应用的发展规律，拟更有效地开展青少年错牙合畸形的隐形矫治工作，推动青少年错牙合畸形早期阻断及综合矫治的发展，提高青少年错牙合畸形隐形矫治技术的水平。     

Outcome assessment of orthodontic clear aligner vs fixed appliance treatment in a teenage population with mild malocclusions

ObjectiveTo assess the efficacy and efficiency of treatment in adolescents presenting with mild malocclusions, comparing outcomes using clear aligners to fixed appliances.Materials and MethodsPatients identified retrospectively and consecutively from one private practice had been treated with either clear aligners (Invisalign, Align Technology, Santa Clara, Calif) or fixed appliances (0.022 Damon, Ormco, Orange, Calif; n = 26/group). Assessments of occlusion were made using the American Board of Orthodontics Discrepancy Index (DI) for initial records and Cast-Radiograph Evaluation (CRE) for final records. Number of appointments, number of emergency visits, and overall treatment time were determined from chart reviews. Data were analyzed using Pearson''s correlation, Wilcoxon rank tests, unpaired t-tests, and Chi-square tests, with significance set to P ≤ .05.ResultsPretreatment, the aligner and fixed groups showed no significant difference in overall severity (DI: 11.9 ± 5.3 vs 11.6 ± 4.8) or in any individual DI category. Posttreatment scores showed finishes for the aligner group had fewer discrepancies from ideal relative to the fixed appliance group (CRE: 30.1 ± 8.3 vs 37.0 ± 9.3; P < .01). Patients treated with aligners had fewer appointments (13.7 ± 4.4 vs 19.3 ± 3.6; P < .0001), fewer emergency visits (0.8 ± 1.0 vs 3.6 ± 2.5; P < .0001), and shorter overall treatment time (16.9 ± 5.7 vs 23.4 ± 4.4 months; P < .0001).ConclusionsOutcomes for treatment of mild malocclusions in adolescents showed equivalent effectiveness of clear aligners compared to fixed appliances, with significantly improved results for clear aligner treatment in terms of tooth alignment, occlusal relations, and overjet. Assessment of the number of appointments, number of emergency visits, and overall treatment time showed better outcomes for treatment with clear aligners.     

The 2005 C.T. Rowland Award orthodontic case report

The C.T. Rowland award is presented annually by the Texas Orthodontic Study Club (formerly "Texas Tweed"). The award was first presented in 1954 in recognition of the group's president, C. T. Rowland. Applicants to the study club, which numbers almost 200 orthodontists from Texas and surrounding states, are required to present five cases for membership. These cases, with before and after records, represent a variety of malocclusions demonstrating the applicants' knowledge and expertise in diagnosing, treating, and finishing cases with quality results. The qualifying committee reviews each applicant's cases and, based on the difficulty of the original malocclusions and the degree of excellence of the finished result, chooses one person to receive their award. The 2005 winner of the C. T. Rowland award is Dr. Kyle Shannon. He is in the exclusive practice of orthodontics in Tulsa, OK.