Orthodontic treatment of a particular subgroup of children with special health care needs,children with craniofacial anomalies: An analysis of treatment length and clinical outcome

Objective:To analyze any differences in the orthodontic treatment between children belonging to a particular subgroup of subjects with special health care needs (SHCN), children with craniofacial anomalies (CFA), and children not diagnosed with SHCN (NO SHCN).Materials and Methods:The study sample consisted of 50 children with SHCN and a confirmed diagnosis of CFA (SHCN/CFA); the control group consisted of 50 NO SHCN children fully matched for age, gender, and type of appliance used. The differences between the two groups were analyzed retrospectively: pre-, posttreatment scores, and score reduction of the Peer Assessment Rating Index (PAR), dental health component (DHC), and aesthetic component (AC) of Orthodontic Treatment Need Index (IOTN), number of appointments, number of simple or complex chair-time appointments, overall treatment time, and age at treatment start and end.Results:There were no statistically significant differences between the SHCN/CFA and NO SHCN groups for number of appointments, overall treatment time, age at treatment start, and age at treatment end (P  =  .682, .458, .535, and .675, respectively). There were statistically significant differences between groups in PAR, DHC, AC pre- and posttreatment, and number of simple and complex chair-time appointments (P  =  .030 and .000; .020 and .023; .000 and .000; .043; and .037; respectively). The reduction of PAR, DHC, and AC scores was not significantly different between groups (P  =  .060, .765, and .825, respectively).Conclusion:The treatment of children with SHCN, in general, and with CFA, in particular, on the one hand involves a higher rate of using complex chair time appointments and an inferior treatment outcome, by the other side implies an overall treatment time and a reduction of PAR, DHC or AC scores similar to the treatment of children not diagnosed with SHCN.     

Another way of looking at treatment stability

Objective:To determine the contribution of normal physiological changes to the overall manifestation of a relapse after orthodontic treatment. We analyzed long-term changes in the dentition of patients with Class I malocclusions after orthodontic treatment compared with a representative group with untreated Class I malocclusions.Materials and Methods:Study participants (n  =  66; mean age, 12 years at treatment initiation) were treated for Class I malocclusions. Dental changes were evaluated at 2, 5, 10, and 15 years after treatment. Control participants (n  =  79) had untreated Class I malocclusions (n  =  53 evaluated at ages 12 and 22 years; n  =  26 evaluated at ages 19 and 39 years). Dental changes were evaluated with the Peer Assessment Rating (PAR) index.Results:In untreated and treated groups, PAR scores increased over time with gender-specific changes. In the untreated groups, the PAR score significantly increased in male participants between the ages of 12 and 22 years (P  =  .04) and in female participants between the ages of 19 and 39 years (P  =  .001). In the treated group, early posttreatment changes were primarily related to the initial treatment response. Later changes in the PAR score could be attributed to physiological changes, with the same gender-specific changes as those observed in the untreated group.Conclusions:The pattern of physiological changes in dentition for participants between the ages of 12 and 39 was different between sexes. Females showed more relapse than males between 10 and 15 years posttreatment. This distinction should be considered when evaluating long-term orthodontic treatment responses.     

Quantitative Light-induced Fluorescence-Digital as an oral hygiene evaluation tool to assess plaque accumulation and enamel demineralization in orthodontics

Objective:To assess the use of Quantitative Light-induced Fluorescence-Digital as an oral hygiene evaluation tool during orthodontic treatment.Materials and Methods:In this prospective, randomized clinical trial, 33 patients undergoing fixed orthodontic appliance treatment were randomly allocated to receive oral hygiene reinforcement at four consecutive appointments using either white light (WL) or Quantitative Light-induced Fluorescence-Digital (QLF) images, taken with a device, as visual aids. Oral hygiene was recorded assessing the QLF images for demineralization, by fluorescence loss (ΔF), and plaque coverage (ΔR30). A debriefing questionnaire ascertained patient perspectives.Results:There were no significant differences in demineralization (P  =  .56) or plaque accumulation (P  =  .82) between the WL and QLF groups from T0 to T4. There was no significant reduction in demineralization, ΔF, in the WL, or the QLF group from T0–T4 (P > .05); however, there was a significant reduction in ΔR30 plaque scores (P < .05). All the participants found being shown the images helpful, with 100% of the QLF group reflecting that it would be useful to have oral hygiene reinforcement for the full duration of treatment compared with 81% of the WL group (OR 2.3; P < .05).Conclusions:Quantitative Light-induced Fluorescence-Digital can be used to detect and monitor demineralization and plaque during orthodontics. Oral hygiene reinforcement at consecutive appointments using WL or QLF images as visual aids is effective in reducing plaque coverage. In terms of clinical benefits, QLF and WL images are of similar effectiveness; however, patients preferred the QLF images.     

Factors associated with long-term patient satisfaction

Objective:To identify factors associated with patient satisfaction at least 5 years after orthodontic treatment.Materials and Methods:A total of 209 orthodontic patients were included in the study. All subjects were treated with upper and lower fixed orthodontic appliances. Dental casts (n  =  627) were examined using the Peer Assessment Rating (PAR) Index pretreatment (T1), at the end of treatment (T2) and at a long-term follow-up (mean, 8.5 years; T3). At T3, a Dental Impact on Daily Living questionnaire was used to assess the long-term effects of orthodontic treatment on daily living and satisfaction with the dentition. Multiple regression analyses were used to quantify associations between patient satisfaction and changes produced by the orthodontic treatment (PAR T2-T1), posttreatment stability (PAR T3), age at the start of treatment (T1), treatment duration (T2-T1), gender, and extraction.Results:Orthodontic treatment produced a significant improvement of 94.2% in the PAR Index (T2-T1), but this change was not associated with the level of satisfaction when the patient was questioned at least 5 years after treatment. Regression analysis showed that satisfaction was significantly associated only with the long-term posttreatment PAR index (r²  =  0.125, P < .0001). No significant association was observed with the severity of malocclusion at the beginning (PAR-T1) or end of the orthodontic treatment (PAR-T2), age at T1, the amount of time taken during orthodontic treatment, gender, or extraction.Conclusions:Over the long term, patient satisfaction is slightly associated with the stability of the orthodontic treatment regardless of the initial occlusal condition or the final result of the orthodontic treatment.     

Comparison of personality traits,attitude toward orthodontic treatment,and pain perception and experience before and after orthodontic treatment

Objective:To compare personality traits, attitude toward orthodontic treatment, and pain perception and experience before and after orthodontic treatment.Materials and Methods:One hundred subjects (50 male and 50 female) were included in this study. The mean (SD) age was 17.5 (2.05) years at T1 and 19.15 (2.32) years at T2. The instruments for data collection were questionnaires that included assessment of patients'' personality traits, attitudes toward orthodontic treatment, and pain perception/experience. Subjects completed the questionnaires at two different times: before orthodontic treatment (T1) and after fixed orthodontic treatment (T2). Subjects were treated by fixed orthodontic appliances for an average (SD) period of 18.64 (0.35) months. Paired sample t-test and chi-square test were used to detect any differences.Results:Significant changes in personality traits were detected after orthodontic treatment irrespective of gender. Neuroticism, openness, agreeableness, and conscientiousness scores were improved (P < .001). A positive attitude toward orthodontic treatment was reported at T1 (4.31 [±1.26]) and improved at T2 (3.98 [±1.16]) irrespective of gender (P < .05). The average (SD) expected pain score (T1) was 4.73 (1.88) and the average (SD) experienced pain score (T2) was 4.63 (1.58). Significant difference in the expected and experienced pain scores was not detected (P  =  .11).Conclusions:Personality traits and attitude toward orthodontic treatment improved after orthodontic treatment. Reported actual pain experience during orthodontic treatment was similar to that expected before treatment.     

Influence of Supplemental Written Information on Adolescent Anxiety,Motivation and Compliance in Early Orthodontic Treatment

Objectives:To test the null hypotheses that supplementation of verbal information with written information when obtaining consent to orthodontic treatment has no effect on (1) anxiety, motivation and apprehension related to treatment and (2) compliance in the early stages of fixed appliance therapy.Materials and Methods:Seventy-six adolescents who were due to start fixed appliance therapy were randomly allocated to receive verbal information only or verbal and written information before orthodontic treatment. Participants'' anxiety, motivation, and apprehension were assessed using a questionnaire that was completed prior to meeting the orthodontic clinician (T1), following consent to treatment (T2), and after 12 weeks of treatment (T3). Appointment attendance, appliance breakages, and periodontal scores were used as measures of patient compliance.Results:Sixty participants completed the study. At T2 there was no change in anxiety scores for either group (P  =  .412); however, increased motivation was detected in the group that had been given both written and verbal information (P  =  .049). At T3 both groups demonstrated similar reductions in anxiety (P  =  .311) and apprehension (P  =  .790) and similar levels of motivation (P  =  .756). A reduction in periodontal scores (P  =  .065), better appointment attendance (P  =  .732), and fewer breakages (P  =  .525) were reported in the group that was given additional information, although these changes were not statistically significant.Conclusions:Supplementation of verbal information with written information resulted in improved motivation for orthodontic treatment but had no statistically significant effect on anxiety, apprehension, or patient compliance.     

Changes in temporomandibular joint disc position and form following Herbst and fixed orthodontic treatment

Objective:To determine the changes in the position and form of the temporomandibular joint articular disc in adolescents with Class II division 1 malocclusion and mandibular retrognathism treated with the Herbst appliance (phase I) and fixed orthodontic appliance (phase II).Materials and Methods:Thirty-two consecutive adolescents went through phase I of treatment and 23 completed phase II. The temporomandibular joints were evaluated qualitatively by means of magnetic resonance images at the beginning of treatment (T1), during phase I (T2), at the end of phase I (T3), and at the end of phase II (T4).Results:Significant changes in disc position were not observed with the mouth closed between T1 × T3 (P  =  .317), T3 × T4 (P  =  .287), or T1 × T4 (P  =  .261). At T2, on average, the disc was positioned regressively. With the mouth open, no difference was observed between T1 × T3 (P  =  .223) or T1 × T4 (P  =  .082). We did observe a significant difference between T3 × T4 (P < .05). Significant changes in the disc form were found with the mouth closed between T1 × T2 (P < .001) and T2 × T3 (P < .001).Conclusions:At the end of the two-phase treatment, in general terms, the position and form of the initial articular discs were maintained; however, in some temporomandibular joints some seemingly adverse effects were observed at T4.     

Self-ligating vs conventional brackets as perceived by orthodontists

Objective:To determine if there are significant clinical differences between self-ligating brackets (SLB) and conventional brackets (CB) during orthodontic treatment, as perceived by orthodontists.Materials and Methods:A survey was developed and distributed to evaluate how SLB compare to CB in terms of orthodontists'' perceptions (n  =  430).Results:SLB were preferred during the initial stage of treatment based on the shorter adjustment appointments and faster initial treatment progress they provided (P < .0001). On the other hand, practitioners preferred CB during the finishing and detailing stages of treatment (P < .0001). CB were also preferred over SLB because they were cheaper and resulted in fewer emergency appointments.Conclusions:The orthodontists'' preference was significantly influenced by (1) the proportion of patients treated with SLB (P < .0001), (2) the number of cases it took them to become accustomed to SLB (P < .0001), and (3) the average appointment intervals associated with SLB (P < .0001).     

Dentoskeletal changes following mini-implant molar intrusion in anterior open bite patients

Objective:To evaluate skeletal and dental changes after intrusion of the maxillary molars in subjects with anterior open bite.Materials and Methods:This retrospective cephalometric study evaluated skeletal and dental changes resulting from the use of maxillary orthodontic mini-implants in 31 consecutively treated patients. Radiographs were taken at the start and end of maxillary molar intrusion to evaluate the associated changes. Statistical analysis was performed using a one-sample t-test.Results:The mean treatment observation time was 1.31 years (SD  =  2.03). The maxillary first molars (P  =  0.0026) and second molars (P  =  0.039) were intruded. However, the mandibular first molars (P  =  0.0004) and second molars (P  =  0.003) erupted in adolescent patients. Both the maxillary and mandibular first molars inclined distally (P  =  0.025 and P  =  0.044, respectively). The mandibular plane angle decreased (P  =  0.036), lower facial height decreased (P  =  0.002), and the occlusal plane angle increased (P  =  0.009). The overbite increased (P < .0001). The ANB angle decreased (P < .0001). Mandibular dental and skeletal changes were more apparent in adolescents, while adults tended toward maxillary changes.Conclusions:Vertical traction from orthodontic mini-implants reduces the maxillary posterior dentoalveolar height, thereby assisting orthodontic closure of anterior open bite. However, simultaneous eruption or extrusion of the mandibular molars should be controlled. Adolescent patients tend to demonstrate more favorable effects of mandibular autorotation than do adults.     

Patient attitudes toward retention and perceptions of treatment success

Objective:To discern patients'' opinions regarding responsibility for orthodontic retention and to determine whether patient attitudes toward retention are related to perceptions of treatment success.Materials and Methods:Questionnaires regarding orthodontic retention were distributed to first-year undergraduate college students (n  =  158), first-year dental students (n  =  183), and retention patients at orthodontic offices (n  =  214). Items included treatment satisfaction, perceived responsibility for retention, type of retainer prescribed, reasons for discontinuing use of retainers, and relapse experienced.Results:Four hundred twenty-eight of 555 participants indicated that they had received orthodontic treatment. Most indicated they were either “satisfied” or “very satisfied” with their teeth, both at the end of treatment (96%) and currently (84%). There was a strong relationship between the perception of stability of tooth position and current satisfaction level (P < .0001). Most individuals (88%) indicated that they themselves were responsible for maintaining the alignment and fit of their teeth. Those who indicated that someone else was responsible were nearly twice as likely to be dissatisfied with their teeth (P  =  .0496). Patients who had been prescribed clear, invisible retainers were significantly more likely to be “very satisfied” currently (50%) compared to those with Hawley (35%) or permanently bonded (36%) retainers (P  =  .0002). Patients with Hawley retainers were significantly less likely to be wearing them currently as prescribed (45%) than those with invisible (65%) or bonded (68%) retainers (P < .0001).Conclusions:Satisfaction with orthodontic results after treatment is related to patient perceptions of responsibility for retention and perceived stability of tooth position. Patients should play a contributory role in formulating orthodontic retention plans.     

Desire for orthodontic treatment and associated factors among adolescents in southern Brazil

Objective:To estimate the prevalence of the desire for orthodontic treatment and investigate associated factors among adolescents in southern Brazil.Materials and Methods:A cross-sectional study was carried out with 704 adolescents aged 12 and 13 years at municipal public schools in the city of Balneário Camboriú (southern Brazil). The adolescents answered a previously tested questionnaire addressing satisfaction with their dental appearance, speech function, chewing function, and the desire for orthodontic treatment. The parents/guardians answered a questionnaire addressing satisfaction with their child''s dental appearance and socioeconomic variables. A trained and calibrated orthodontist collected clinical data on malocclusion using the Dental Aesthetic Index (DAI). Statistical analysis was performed using multivariate Poisson regression with robust variance.Results:The prevalence of the desire for orthodontic treatment was 69.6% (490/704). In the adjusted analysis, the outcome was significantly more prevalent among girls (P < .001), those with difficulty chewing (P  =  .026), those dissatisfied with their dental appearance (P < .001), and those with greater malocclusion severity (P < .001). The following orthodontic characteristics were associated with the desire for orthodontic treatment in the multivariate model: diastema in anterior segment (P < .001), anterior maxillary irregularity (P < .001), maxillary overjet ≥6 mm (P < .001), and mandibular overjet (P  =  .047).Conclusions:The desire for orthodontic treatment among 12- and 13-year-old adolescents is influenced by gender, dissatisfaction with one''s dental appearance, difficulty chewing, malocclusion severity, and orthodontic characteristics. These findings should be considered together with normative indications regarding the need for orthodontic treatment in adolescents.     

Pain control in orthodontics using a micropulse vibration device: A randomized clinical trial

Objective:To investigate the relationship between a micropulse vibration device and pain perception during orthodontic treatment.Materials and Methods:This study was a parallel group, randomized clinical trial. A total of 58 patients meeting eligibility criteria were assigned using block allocation to one of two groups: an experimental group using the vibration device or a control group (n  =  29 for each group). Patients used the device for 20 minutes daily. Patients rated pain intensity on a visual analog scale at appropriate intervals during the weeks after the separator or archwire appointment. Data were analyzed using repeated measures analysis of variance at α  =  .05.Results:During the 4-month test period, significant differences between the micropulse vibration device group and the control group for overall pain (P  =  .002) and biting pain (P  =  .003) were identified. The authors observed that perceived pain was highest at the beginning of the month, following archwire adjustment.Conclusion:The micropulse vibration device significantly lowered the pain scores for overall pain and biting pain during the 4-month study period.     

Differences in psychological traits between lingual and labial orthodontic patients: Perfectionism,body image,and the impact of dental esthetics

Objective:To examine some of the patients'' psychological traits in relation to their levels of perfectionism and their body image, and to discover whether these differ between lingual and labial orthodontic patients.Materials and Methods:A cross-sectional study was designed with a consecutive sample of 80 patients attending a private orthodontic office. Three questionnaires were used to assess the patients'' body image and level of perfectionism. The mean age was 33 years. The men numbered 32 and the women 48. The validated Spanish version of the Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ) was used to assess the psychosocial impact of their dental esthetics. The Multidimensional Perfectionism Scale (MPS) was used to assess how perfectionist the patients were. A version of the Multidimensional Body-Self Relations Questionnaire (MBSRQ) was used for assessment of their body image. Student''s t-test was used to compare the means and 95% confidence intervals (P < .05), and a logistic regression model was used for multivariate analysis.Results:The PIDAQ (55.4 vs 60, P  =  .218) and MBSRQ (128.7 vs 125.9, P  =  .523) results of the patients who chose lingual orthodontics did not differ significantly from those who opted for labial orthodontics. However, the MPS scores of the lingual orthodontic patients were significantly higher (95.9 vs 86.3, P  =  .044), and high social class, over 30 years of age, and perfectionist traits were significant independent variables in this group.Conclusions:This pilot study may indicate that lingual orthodontic patients are more perfectionists than labial orthodontic patients.     

Porcelain Surface Alterations and Refinishing After Use of Two Orthodontic Bonding Methods

Objective:To compare porcelain surfaces at debonding after use of two surface preparation methods and to evaluate a method for restoring the surface.Materials and Methods:Lava Ceram feldspathic porcelain discs (n  =  40) underwent one of two surface treatments prior to bonding orthodontic brackets. Half the discs had sandblasting, hydrofluoric acid, and silane (SB + HF + S), and the other half, phosphoric acid and silane (PA + S). Brackets were debonded using bracket removing pliers, and resin was removed with a 12-fluted carbide bur. The surface was refinished using a porcelain polishing kit, followed by diamond polishing paste. Measurements for surface roughness (Ra), gloss, and color were made before bonding (baseline), after debonding, and after each step of refinishing. Surfaces were also examined by scanning electron microscopy (SEM). Data was analyzed with 2-way ANOVA followed by Tukey HSD tests (α  =  0.05).Results:The SB + HF + S bonding method increased Ra (0.160 to 1.121 µm), decreased gloss (41.3 to 3.7) and altered color (ΔE  =  4.37; P < .001). The PA + S method increased Ra (0.173 to 0.341 µm; P < .001), but the increase in Ra was significantly less than that caused by the SB + HF + S bonding method (P < . 001). The PA + S method caused insignificant changes in gloss (41.7 to 38.0) and color (ΔE  =  0.50). The measurements and SEM observations showed that changes were fully restored to baseline with refinishing.Conclusions:The PA + S method caused significantly less damage to porcelain than the SB + HF + S method. The refinishing protocol fully restored the porcelain surfaces.     

Contribution of cone beam computed tomography to the detection of apical root resorption after orthodontic treatment in root-filled and vital teeth

Objective:To investigate whether root-filled teeth are similar to vital pulp teeth in terms of apical root resorption (ARR) after orthodontic treatment.Materials and Methods:An original sample of cone beam computed tomography (CBCT) images of 1256 roots from 30 orthodontic patients were analyzed. The inclusion criteria demanded root-filled teeth and their contralateral vital teeth, while teeth with history of trauma had to be excluded to comply with exclusion criteria. CBCT images of root-filled teeth were compared before and after orthodontic treatment in a split-mouth design study. Tooth measurements were made with multiplanar reconstruction using axial-guided navigation. The statistical difference between the treatment effects was compared using the paired t-test.Results:Twenty posterior root-filled teeth and their contralaterals with vital pulp were selected before orthodontic treatment from six adolescents (two boys and four girls; mean [SD] age 12.8 [1.8] years). No differences were detected between filled and vital root lengths before treatment (P  =  .4364). The mean differences in root length between preorthodontic and postorthodontic treatment in filled- and vital roots were −0.30 mm and −0.16 mm, respectively, without any statistical difference (P  =  .4197) between them.Conclusion:There appears to be no increase in ARR after orthodontic treatment in root-filled teeth with no earlier ARR.     

Effects of remineralization procedures on shear bond strengths of brackets bonded to demineralized enamel surfaces with self-etch systems

Objective:To compare the effects of different remineralization procedures on the surface roughness of teeth, shear bond strengths (SBSs), and Adhesive Remnant Index scores of self-etching primer (SEP) used to bond orthodontic brackets to previously treated demineralized enamel surfaces.Materials and Methods:A total of 140 extracted human premolar teeth were randomly divided into seven equal groups. Group I was the control group. A demineralization procedure was performed in the other six groups. A remineralization procedure was performed before bonding by using casein phosphopeptide-amorphous calcium phosphate, fluoride, a microabrasion mixture (18% hydrochloric acid-fine pumice), a microabrasion agent, and resin infiltration in groups III to VII. Brackets were bonded using a self-etching primer/adhesive system. The specimens were tested for SBS. The roughness and morphology of the enamel surfaces were analyzed using profilometer and scanning electron microscopy. Data were analyzed with analysis of variance, Tukey, and G-tests at the α  =  .05 level.Results:Significant differences were found in the SBS values among the seven groups (F  =  32.69, P  =  .003). The lowest SBS value was found in group II (2.62 ± 1.46 MPa). No significant differences were found between groups I, III, and VII, between groups III and IV, or between groups V and VI. The differences in the roughness values were statistically significant among the groups (P  =  .002).Conclusions:Remineralization procedures restore the decreased SBS of orthodontic brackets and decrease surface roughness caused by enamel demineralization. SEPs provide clinically acceptable SBS values for bonding orthodontic brackets to previously treated demineralized enamel surfaces.     

Response of the maxillary dentition to a statically determinate one-couple system with tip-back mechanics: A prospective clinical trial

Objective:To quantify the effects of tip-back mechanics on the maxillary first molars and incisors.Materials and Methods:Sixteen subjects with Class II end-on malocclusion were treated with an intrusion arch to achieve distalization of the maxillary molar through tip-back mechanics. Lateral cephalograms were taken prior to molar tip-back (T1), after molar tip-back (T2), and after molar root uprighting (T3). Data were analyzed using the Friedman’s and Wilcoxon signed rank tests to evaluate differences in time points (P ≤ .016).Results:The maxillary first molar distalized 1.53 mm (P = .001) with 6.65° (P = .001) of distal tipping and 0.86 mm (P = .001) of extrusion at T2. Minor relapse of the first molar (mesial direction) was seen at T3. The maxillary incisors flared labially 0.4 mm, and the incisor root apex moved palatally 1.19 mm (P = .005) at T2. At T3, the incisor root apex moved palatally 1.5 mm (P = .003) from T1. An angular change from T1 of 3.31° (P = .008) and 3.53° (P = .014) was seen at T2 and T3, respectively, as a result of palatal root movement of the maxillary incisors.Conclusions:A significant amount of distalization of maxillary molars was attained at the crown level with tip-back mechanics. Palatal root angulation change was significant in the incisors with minimal anteroposterior movement of the incisal edge.     

Combined effects of repeated oral hygiene motivation and type of toothbrush on orthodontic patients: A blind randomized clinical trial

Objective:To investigate the effects on plaque index (PI) scores of manual or electric toothbrush with or without repeated oral hygiene instructions (OHI) and motivation on patients wearing fixed orthodontic appliances.Materials and Methods:One month after the orthodontic fixed appliance bonding on both arches, 60 patients were randomly assigned to four groups; groups E₁ (n  =  15) and E₂ (n  =  15) received a powered rotating-oscillating toothbrush, and groups M₁ (n  =  15) and M₂ (n  =  15) received a manual toothbrush. Groups E₁ and M₁ received OHI and motivation at baseline (T0) and after 4, 8, 12, 16, and 20 weeks (T4, T8, T12, T16, and T20, respectively) by a Registered Dental Hygienist; groups E₂ and M₂ received OHI and motivation only at baseline. At each time point a blinded examiner scored plaque of all teeth using the modified Quigley-Hein PI.Results:In all groups the PI score decreased significantly over time, and there were differences among groups at T8, T12, T16, and T20. At T8, PI scores of group E₁ were lower than those of group E₂, and at T12, T16, and T20, PI scores of groups M₁ and E₁ were lower compared to those of groups M₂ and E₂. A linear mixed model showed that the effect of repeated OHI and motivation during time was statistically significant, independently from the use of manual or electric toothbrush.Conclusions:The present results showed that repeated OHI and motivation are crucial in reducing PI score in orthodontic patients, independent of the type of toothbrush used.     

Impact of wearing fixed orthodontic appliances on quality of life among adolescents: Case-control study

Objective:To investigate the impact of wearing a fixed orthodontic appliance on oral health-related quality of life (OHRQoL) among adolescents.Materials and Methods:A case-control study (1∶2) was carried out with a population-based randomized sample of 327 adolescents aged 11 to 14 years enrolled at public and private schools in the City of Brumadinho, southeast of Brazil. The case group (n  =  109) was made up of adolescents with a high negative impact on OHRQoL, and the control group (n  =  218) was made up of adolescents with a low negative impact. The outcome variable was the impact on OHRQoL measured by the Brazilian version of the Child Perceptions Questionnaire (CPQ_11–14) – Impact Short Form (ISF:16). The main independent variable was wearing fixed orthodontic appliances. Malocclusion and the type of school were identified as possible confounding variables. Bivariate and multiple conditional logistic regressions were employed in the statistical analysis.Results:A multiple conditional logistic regression model demonstrated that adolescents wearing fixed orthodontic appliances had a 4.88-fold greater chance of presenting high negative impact on OHRQoL (95% CI: 2.93–8.13; P < .001) than those who did not wear fixed orthodontic appliances. A bivariate conditional logistic regression demonstrated that malocclusion was significantly associated with OHRQoL (P  =  .017), whereas no statistically significant association was found between the type of school and OHRQoL (P  =  .108).Conclusions:Adolescents who wore fixed orthodontic appliances had a greater chance of reporting a negative impact on OHRQoL than those who did not wear such appliances.