Adult orthodontics: a quality assessment of Internet information

Objectives: This study evaluated the quality, reliability and readability of information on the Internet on adult orthodontics. Design: A quality assessment of adult orthodontic websites. Setting: Postgraduate Orthodontic Unit, Cork University Dental School and Hospital, Cork, Ireland. Method: An Internet search using three search engines (Google, Yahoo and Bing) was conducted using the terms (‘adult orthodontics’ and ‘adult braces’). The first 50 websites from each engine and under each search term were screened and exclusion criteria applied. Included websites were then assessed for quality using four methods: the HON seal, JAMA benchmarks, the DISCERN instrument and the LIDA tool. Readability of included websites was assessed using the Flesch Reading Ease Score (FRES). Results: Only 13 websites met the inclusion criteria. Most were of US origin (n?=?8; 61%). The authors of the websites were dentists (n?=?5; 39%), professional organizations (n?=?2; 15%), past patients (n?=?2; 15%) and unspecified (n?=?4; 31%). Only 1 website displayed the HON seal and three websites contained all JAMA benchmarks. The mean overall score for DISCERN was 3.9/5 and the mean total LIDA score was 115/144. The average FRES score was 63.1/100. Conclusions: The number of informative websites on adult orthodontics is low and these are of moderate quality. More accurate, high-quality Internet resources are required on adult orthodontics. Recommendations are made as to how this may be achieved.     

Commentaries on scientific paper published in this edition

Abstract

Accurate easy placement bonded retainers have long been a desired aspect of contemporary orthodontic treatment. This article offers the reader a simple and precise method of placing a fixed bonded retainer. This technique also has the advantage of providing a retainer that can be used as both the positioner and the dual removable retainer.     

Quality evaluation of the available Internet information regarding pain during orthodontic treatment

Objective:To investigate the quality of the data disseminated via the Internet regarding pain experienced by orthodontic patients.Materials and Methods:A systematic online search was performed for ‘orthodontic pain’ and ‘braces pain’ separately using five search engines. The first 25 results from each search term–engine combination were pooled for analysis. After excluding advertising sites, discussion groups, video feeds, and links to scientific articles, 25 Web pages were evaluated in terms of accuracy, readability, accessibility, usability, and reliability using recommended research methodology; reference textbook material, the Flesch Reading Ease Score; and the LIDA instrument. Author and information details were also recorded.Results:Overall, the results indicated a variable quality of the available informational material. Although the readability of the Web sites was generally acceptable, the individual LIDA categories were rated of medium or low quality, with average scores ranging from 16.9% to 86.2%. The orthodontic relevance of the Web sites was not accompanied by the highest assessment results, and vice versa.Conclusions:The quality of the orthodontic pain information cited by Web sources appears to be highly variable. Further structural development of health information technology along with public referral to reliable sources by specialists are recommended.     

Periodontal implications of bonded versus removable retainers

Removable retainers have been used by clinicians since the early years of orthodontic practice. During the last decades, an increasing number of cases are retained with bonded lingual retainers. The current study was performed to evaluate whether significant differences in gingival conditions exist between patients who wear removable or fixed retainers. Differences in build-up of plaque and calculus were also investigated. Maxillary and mandibular measurements were taken at baseline (just before debonding) and 1, 3, and 6 months later, from canine to canine on 36 patients. Among these patients, 22 had fixed retainers, and 14 wore removable retainers. The gingival condition was scored according to three parameters: Modified Gingival Index, bleeding on probing, and gingival crevicular fluid flow. After staining with Diaplac, the Plaque Index was registered. The amount of calculus was measured with a calibrated periodontal probe. Gingival inflammation decreased from baseline throughout the entire period of retention. A comparable limited gingival inflammation was found in the presence of both types of retainers. Slightly more plaque and calculus were present on the lingual surfaces in the fixed retainer group. This did not result in more pronounced gingival inflammation than in the removable retainer group, within the evaluated period. (Am J Orthod Dentofac Orthop 1997;112:607-616.)     

Anterior tooth wear and retention type until 5 years after orthodontic treatment

Objectives. To study occlusal wear of anterior teeth in orthodontic patients retained with different retainers until 5 years post-treatment, and to investigate whether type of retention influences occlusal wear. Material and methods. Orthodontic patients (n=222), aged 15 years maximally at the start of treatment, were followed until 5 years post-treatment. In the maxilla, a retainer bonded on all six teeth or a removable retainer was used; in the mandible, a lingual retainer was bonded on all anterior teeth or on canines only. Dental casts were analyzed before treatment (T₀), after treatment (T₁), and 5 years post-treatment (T₅). Incisal and canine wear were scored by applying a grading scale. Intercanine width, overjet, and overbite were measured with an electronic caliper. Statistics used were: Paired samples t-test for differences over time; Pearson correlation coefficients for associations between wear and retention type; and backward linear regression for influence of retention type on wear. Results. There was an increase in wear during all time periods and for all teeth. From T₀ to T₅ an increase in maxillary intercanine width and maxillary retention had an effect on changes in canine wear. Incisal wear was associated with an increase in upper intercanine width (T₁–T₅). For both arches, an increase in maxillary intercanine width during treatment was associated with less progression of canine and incisal wear, but the explained variance was low, 13.4% and 19.3%, respectively. Conclusions. Retention type and, occasionally, an increase in intercanine width influence anterior teeth wear post-treatment. However, the clinical significance and impact of the examined retention methods on occlusal wear are small.     

Retention protocols and use of vacuum-formed retainers among specialist orthodontists

Abstract

Objective: To evaluate retention protocols and use of vacuum-formed retainers (VFRs) among specialist orthodontists.

Design: Postal/electronic (e-) questionnaire.

Setting: Republic of Ireland.

Participants: Members of the Dental Council of Ireland Specialist Register of Orthodontists and/or Orthodontic Society of Ireland.

Methods: A pilot-tested questionnaire was distributed to 123 eligible specialist orthodontists. Questions addressed respondent demographics, preferred retainer choice in the maxillary and mandibular arches, prescribed wear protocols, VFR characteristics and factors influencing retainer choice. Statistical analyses were performed using PASW® version 18.

Results: The response rate was 82%. VFRs were the most commonly chosen retainer, prescribed by 53% of respondents in the maxilla and 33% in the mandible. Full-time followed by part-time wear of removable retainers (RRs) was the wear protocol favoured by the majority (70–76%). Full occlusal coverage was the VFR design favoured by 93%. VFR sheet thicknesses of 1.0 mm (68%) and 0.75 mm (16%) were most commonly prescribed. Seventeen per cent were aware that their patients used their VFRs as a receptacle for dental bleaching gel. Life-time wear of retainers was advised by 67–78%. The operator factor that most influenced retainer choice was the pre-treatment situation (88%).

Conclusions: VFRs were the most common retainer choice in the maxilla and mandible with full-time wear followed by part-time wear of RRs favoured by most. Full occlusal coverage with a thickness of 1.0 mm was the VFR design prescribed by the majority. More than one in six specialist orthodontists were aware that their patients used their VFRs as a receptacle for dental bleaching gel.     

Orthognathic surgery: is patient information on the Internet valid?

The aims of this study were to evaluate the quality and reliability of UK websites providing information on orthognathic and jaw surgery to patients. An Internet search engine (www.google.com) was used to identify websites containing medical information on 'orthognathic surgery' and 'jaw surgery'. Of over 144,000 links for orthognathic surgery and 700,000 for jaw surgery, the first 100 were examined in detail. After excluding discussion groups, news and video feeds, and removing duplicate sites, only 25 relevant websites remained which were then evaluated using the DISCERN instrument (www.discern.org.uk/discern_instrument.php). Through the 16 questions assessing the reliability and quality of the consumer information which are scored from 1 to 5, a relative index of the quality of the information is produced. The maximum score attainable for an excellent website is 80. Of the 25 websites that were scored, DISCERN indicated the majority of websites fell well below the maximum score. The highest score achieved by one of the websites according to the DISCERN tool was 64 of 80 and the lowest score achieved was 21 of 80. The websites achieving maximum and minimum score were Wikipedia and qualitydentistry.com, respectively. By directing patients to validated websites, clinicians can ensure patients find appropriate information; however, further development of websites relating to orthognathic surgery is required. Internet information should be updated on a regular basis to account for improvements in orthodontic and surgical care.     

透明压膜保持器与传统可摘保持器对牙周健康的影响

目的：观察透明压膜保持器是否影响牙周组织的健康。方法：62例正畸患者固定矫治结束、去掉固定矫治器。进行全口牙周洁治、牙面抛光后，测量临床牙周指标(PD、PLI、GI)作为基线水平；随机分为2组，分别戴入透明压膜保持器与传统可摘保持器，测量1周、1个月及3个月临床牙周指标。结果：戴入透明压膜保持器临床牙周指标显著增高(比传统可摘保持器)。结论：透明压膜保持器对牙周组织健康有影响，对戴入透明压膜保持器的患者加强口腔卫生保健是十分重要的。     

Twelve-year follow-up of mandibular incisor stability: Comparison between two bonded lingual orthodontic retainers

Objective:To compare the long-term outcome 9 years after removal of two different types of fixed retainers used for stabilization of the mandibular anterior segment.Materials and Methods:Sixty-four children who had undergone orthodontic treatment with fixed appliances in both arches were divided into two groups depending on which kind of retainer being used. Twenty-eight of the patients had a canine-to-canine retainer bonded to the canines and 36 had a bonded twistflex retainer 3-3, bonded to each tooth. Measurements were made on study models and lateral head radiographs, before and after treatment, 6 years after treatment, and 12 years after treatment, with a mean of 9.2 years after removal of the retainers.Results:No significant differences were found between the two groups at the long-term follow-up according to Little''s Irregularity Index or available space for the mandibular incisors. The overjet and overbite were reduced after treatment in both groups and stayed stable throughout the observation period. Also, no differences in bonding failures between the two retainers were found.Conclusions:Both a canine-to-canine retainer bonded only to the canines and a twistflex retainer 3-3 bonded to each tooth can be recommended. However, neither of the retention types prevented long-term changes of mandibular incisor irregularity or available space for the mandibular incisors after removal of the retainers.     

Which way forward? Fixed or removable lower retainers

OBJECTIVE: To determine whether lower lingual, canine to canine, bonded multistrand retainers prevent relapse of lower labial segment alignment following fixed appliance therapy and to compare this with lower Hawley-type removable retainers. MATERIALS AND METHODS: Two groups of 29 patients were identified. Group 1 had bonded lower canine to canine multistrand retainers placed following debonding, whereas Group 2 had lower Hawley-type retainers (with acrylic labial to the incisors) fitted following debonding. Study models were taken of all patients at debonding (T(1)) and at least 1 year post debonding (T(2)). Changes in Little's index over the study period were recorded using a reflex microscope. RESULTS: Statistically significant changes in Little's index occurred in the lower labial segment of both study groups (P = .001) over the observation period. There was no statistically significant difference in the amount of change in Little's index between the bonded and removable retainer groups (P = .13). Bonded retainers tended to be placed in older patients (P = .02). CONCLUSIONS: Relapse can occur in the lower labial segment with both fixed and removable retainers. The amount of relapse seen with both types of retainer is not statistically significantly different.     

Clinical comparison of a multistranded wire and a direct-bonded polyethylene ribbon-reinforced resin composite used for lingual retention.

OBJECTIVE: The reliability of posttreatment canine-to-canine retention with resin composite retainers reinforced with plasma-treated woven polyethylene ribbons was compared to the reliability of directly bonded, multistranded wire retainers. METHOD AND MATERIALS: This prospective study was based on an assessment of 20 consecutive patients (eight women and 12 men with a mean age of 22.4 years) who required a fixed canine-to-canine retainer after undergoing orthodontic treatment. The type of retainer used was randomized for each patient. A follow-up examination was carried out once every 3 months. The length of time the retainers stayed in place without resin fracture or loosening from the teeth at one or more points was evaluated. The study's endpoint was 24 months after the retainer had been bonded. RESULTS: The ribbon-reinforced retainer remained in place for an average of 11.5 months, and the multistranded wire for a mean of 23.6 months. The difference was statistically significant. CONCLUSION: In terms of reliability for permanently fixed orthodontic retention from canine to canine, the direct-bonded multistranded wire is superior to the plasma-treated polyethylene woven ribbon and resin retainer.     

Posterior occlusion changes with a Hawley vs Perfector and Hawley retainer: A follow-up study

Objective:To characterize postorthodontic settling of the posterior occlusion of patients wearing Hawley retainers vs patients who initially wore Perfector retainers and then switched to Hawley retainers.Materials and Methods:This follow-up study was based on 40 patients (25 Perfector and 15 Hawley), who were part of a larger sample of 50 patients randomly assigned to wear either Hawley or Perfector retainers. The Perfector patients were given Hawley retainers 2 months after retainer delivery. Occlusal bite registrations were scanned and traced to quantify posterior areas of contact and near contact (ACNC). A seven-item questionnaire was used to assess the patient''s perception of occlusion. Measurements were obtained at the on the day of retainer delivery, 2 months post delivery, 6 months post delivery, and 8 months post delivery.Results:ACNC increased significantly (P < .05) during the first 6 months of retainer wear. The ACNC of the Hawley and Perfector/Hawley groups increased by 129% and 105%, respectively, over 8 months of retention. The greatest increases in ACNC occurred during the first 2 months. The ACNC further increased between 2 and 6 months in both groups. The Perfector/Hawley group also showed slight increases in ACNC between 6 and 8 months. Overall group differences were not statistically significant. The Perfector/Hawley group perceived greater improvements in occlusion than the Hawley group, but group differences after 8 months were small.Conclusions:Substantial amounts of settling occurred at decelerating rates during the first 6 months after retainer delivery. No significant differences in ACNC were found between the Hawley and Perfector/Hawley groups after 8 months of retainer wear.     

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.     

A bonding technique for fixed maxillary retainers

Abstract

Maintaining incisor alignment is an important goal of orthodontic retention and can only be guaranteed by placement of an intact, passive and permanent fixed retainer. Here we describe a reliable technique for bonding maxillary retainers and demonstrate all the steps necessary for both technician and clinician. The importance of increasing the surface roughness of the wire and teeth to be bonded, maintaining passivity of the retainer, especially during bonding, the use of a stiff wire and correct placement of the retainer are all discussed. Examples of adverse tooth movement from retainers with twisted and multistrand wires are shown.     

Speech effects of Hawley and vacuum-formed retainers by acoustic analysis: A single-center randomized controlled trial

Objective:To investigate the effects of alteration on speech articulation of adult patients between Hawley retainers and vacuum-formed retainers by an objective acoustic analysis of vowels and voiceless fricatives.Materials and Methods:Twenty adults, aged 19.0–29.0 years, who had just finished active orthodontic treatment were included in this study. They were divided into a Hawley retainer group and a vacuum-formed retainer group by sortation randomization method. The assessment of speech sounds was performed objectively using acoustic analysis before and after retainer application at the following time points: before wearing (T0), immediately after wearing (T1), and at 24 hours (T2), 1 week (T3), 1 month (T4), and 3 months (T5).Results:The production of /з:/, /i:/, /f/, /θ/, /s/, and /∫/ sounds for the Hawley retainer group and /i:/, /θ/, /s/, and /∫/ sounds for the vacuum-formed retainer group showed severe speech impairment according to acoustic analysis (P < .05). A comparison of the Hawley retainer group with the vacuum-formed retainer group revealed that the performance of /i:/, /f/, and /s/ sounds were significantly different (P < .05).Conclusion:Although sound distortion could be found in both the Hawley retainer group and the vacuum-formed retainer group, changes in articulation were more obvious in the Hawley retainer group.     

Level of Satisfaction in the Use of the Wraparound Hawley and Thermoplastic Maxillary Retainers

ObjectiveTo compare the level of satisfaction in the use of wraparound Hawley and thermoplastic maxillary retainers.Materials and MethodsThe study sample included 70 orthodontic patients (24 males and 46 females), who were in the retention stage (mean age = 20.80 years). All patients wore the two types of maxillary retainer for 1 month each, along with a 3×3 fixed mandibular retainer. After the use of each retainer, the patients responded to a questionnaire evaluating the level of satisfaction with their use of the maxillary retainer. Intergroup comparison was performed by independent t tests. Chi-square test was used to evaluate preference for the type of retainer by gender.ResultsThe thermoplastic retainer was better for swallowing and the wraparound Hawley appliance was better for hygiene and durability. The other factors evaluated (adaptation, speech, comfort, esthetics, satisfaction, and fitting) did not show significant differences between the retainers. There was also no significant difference in preference for the appliances.ConclusionsRegarding the overall satisfaction and the preference, there was no difference between the wraparound Hawley and thermoplastic retainers. The wraparound Hawley appliance was better in hygiene and resistance than the thermoplastic retainer; and the thermoplastic appliance was better than the wraparound Hawley for swallowing fluids and saliva.     

Anterior tooth alignment: A comparison of orthodontic retention regimens 5 years posttreatment

Objective:To assess orthodontic treatment outcome at debonding and at 3 and 5 years after orthodontic treatment and to investigate the influence of different retention protocols on anterior tooth alignment.Materials and Methods:Using the Peer Assessment Rating (PAR) Index, 169 patients (74 boys, 95 girls) were analyzed at four stages: pretreatment (T0), posttreatment (T1), 3 years posttreatment (T3), and 5 years posttreatment (T5). The PAR anterior component scores (ACSs) were compared between groups with different retention protocols. In the maxilla, protocols were removable retainer until T3 (MAX1), removable and fixed retainer until T3 (MAX2), and removable retainer until T3 and fixed retainer until T5 (MAX3). In the mandible, protocols were no retainer (MAND1), fixed 3-3 retainer until T3 (MAND2), and fixed 3-3 retainer until T5 (MAND3).Results:Mean weighted improvement in PAR score was 88.3% at T1, 86.4% at T3, and 82.1% at T5. The ACS for the maxilla showed no significant differences between the retention protocols at any time point. In the mandible, the group without retention showed a gradual but not significant deterioration in ACS throughout the posttreatment period. At T5 there was a significant difference in ACS between the group that had the retainer removed at T3 and the group that kept the retainer.Conclusion:The 5-year treatment outcome, as measured by the PAR Index, was good. Stability of the maxillary anterior alignment 5 years posttreatment did not appear to be influenced by choice of retention protocol. Mandibular anterior alignment was significantly better for the group using a fixed retainer compared with the group where the retainer was removed 3 years posttreatment.     

Orthodontic bonded retainers

Retention is usually necessary following orthodontic treatment to overcome the elastic recoil of the periodontal supporting fibres and to allow remodelling of the alveolar bone. The degree of change is variable and largely unpredictable. Bonded lingual retainers have been shown to be an effective means of retaining aligned anterior teeth in the post-treatment position in the long term. Two basic designs of lingual bonded retainers are currently in use. Rigid mandibular canine-to-canine retainers are attached to the canines only. They are effective in maintaining intercanine width but less so in preventing individual tooth rotations. Flexible spiral wire retainers are bonded to each tooth in the segment, their flexibility allowing for physiological movement of the teeth. This design is more effective at preventing rotation of the bonded teeth. Failure of bonded retainers may occur at the wire-composite interface, at the adhesive-enamel interface or as a stress fracture of the wire. Failure of a retainer may lead to unwanted tooth movement. In many cases it will be possible to repair the appliance in the mouth. However, in some instances it will be necessary to replace the retainer. A disadvantage of fixed retainers is that they complicate oral hygiene procedures, and favour the accumulation of plaque and calculus. Despite this, the presence of a bonded retainer appears to cause no increase in incidence of caries or periodontal disease. Use of interdental cleaning aids is required to ensure adequate oral hygiene.     

Upper bonded retainers: Survival and failure rates

Objective:To assess the frequency and type of upper bonded retainer failure and to identify possible predisposing factors.Materials and Methods:The records of 466 consecutive patients with upper bonded retainers were analyzed retrospectively with respect to retainer failures and failure type as well as timing of failure, differences among operators, and the number of defects of the multibracket appliances (MB) prior to the retention period.Results:A total of 58.2% of all patients experienced retainer failures. The average failure odds were 1.26 failures per retainer. The odds were highest for 3-3 retainers (1.37) and lowest for the 1-1 retainer (0.54). The detachment and total loss rates were significantly influenced by operator experience—both rates were lower for experienced practitioners. Total retainer losses occurred more frequently in case of previous MB defects, while retainer fractures were seen more frequently when the retainer included the canines.Conclusions:Upper bonded retainer failures are a frequent problem during the retention period (58.2% of patients). Less operator experience correlated with higher failure rates. An increased number of total retainer losses must also be expected with a decreasing number of bonding sites and in cases involving previous MB defects.