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).     

Current trends in headgear use for the treatment of Class II malocclusions

Objective:To investigate American and Canadian orthodontists’ opinions and perceptions on the use of headgear in the treatment of Class II malocclusions.Materials and Methods:An online survey was sent to randomly chosen orthodontists (n  =  1000).Results:The study was completed by 948 orthodontists; 62% of the orthodontists indicated that they were using headgear in their practice. Those who were not using the appliance (38%) reported that this was mainly due to the availability of better Class II correctors in the market and lack of patient compliance. Of those who use headgear, 24% indicated that the emphasis on headgear use during their residency was an influential aspect of their decision making (P < .05). Nearly a quarter of those who do not use headgear reported that learning about other Class II correctors through continuing education courses was an important factor (P < .05). There was no difference between the headgear users and nonusers in the year and location of practice. Compared with previous studies, this study showed a decline in the use of headgear among orthodontists.Conclusions:Despite a decline, more than half of the orthodontists (62%) believe headgear is a viable treatment. Availability of Class II correctors in the market and familiarity with these appliances though continuing education courses are the reasons for the remaining 38% of orthodontists to abandon use of the headgear.     

Communication practices and preferences between orthodontists and general dentists

Objective:To evaluate similarities and differences in orthodontists'' and general dentists'' perceptions regarding their interdisciplinary communication.Materials and Methods:Orthodontists (N  =  137) and general dentists (N  =  144) throughout the United States responded to an invitation to participate in a Web-based and mailed survey, respectively.Results:The results indicated that orthodontists communicated with general dentists using the type of media general dentists preferred to use. As treatment complexity increased, orthodontists shifted from one-way forms of communication (letters) to two-way forms of communication (phone calls; P < .05). Both orthodontists and general dentists reported that orthodontists'' communication regarding white spot lesions was inadequate. When treating patients with missing or malformed teeth, orthodontists reported that they sought input from the general dentists at a higher rate than the general dentists reported (P < .005).Conclusions:Orthodontists'' and general dentists'' perceptions of how often specific types of media were used for interdisciplinary communication were generally similar. They differed, however, with regard to how adequately orthodontists communicated with general dentists and how often orthodontists sought input from general dentists. The methods and extent of communication between orthodontists and general dentists need to be determined on a patient-by-patient basis.     

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.     

Perceptions of soft tissue laser use in orthodontics: A survey of orthodontists,periodontists, and general dentists

Objectives:To compare attitudes of orthodontists, periodontists, and general dentists regarding the use of soft tissue lasers by orthodontists during the course of orthodontic treatment.Materials and Methods:An analogous survey was developed to evaluate and compare the current opinions of a representative sample (n  =  538) of orthodontists (61.3%), periodontists (24.3%), and general dentists (14.3%) regarding orthodontists'' use of soft tissue lasers.Results:The majority (84%) of orthodontists, periodontists, and general dentists regarded the use of a soft tissue laser by orthodontists as appropriate. When compared to orthodontists and general dentists, a lower percentage of periodontists indicated that soft tissue laser use by orthodontists was appropriate (P < .01). For each of the eight specific soft tissue laser procedures investigated, periodontists reported a significantly lower level of appropriateness than did orthodontists and general dentists (P < .01). Around 75% of the total sample believed that referral would not be affected by the use of soft tissue lasers by orthodontists.Conclusions:Orthodontists, periodontists, and general dentists differed in their opinions of the perceived appropriateness of soft tissue laser use by orthodontists, with periodontists reporting a lower level of appropriateness. Clinicians need to communicate effectively to ensure that orthodontic patients in need of adjunctive soft tissue surgery are treated to the accepted standard of care.     

Cranial base characteristics in anteroposterior malocclusions: A meta-analysis

Objective:To investigate cranial base characteristics in malocclusions with sagittal discrepancies.Materials and Methods:An electronic search was performed in PubMed, Embase, Web of Science, and the Cochrane Library. A fixed- or random-effect model was applied to calculate weighted mean difference with 95% confidence intervals (CIs) according to statistical heterogeneity. Outcome measures were anterior, posterior, and total cranial base length and cranial base angle. Sensitivity analysis and publication bias were conducted.Results:Twenty studies that together included 1121 Class I, 1051 Class II, and 730 Class III cases qualified for the final analysis. Class III malocclusion demonstrated significantly reduced anterior (95% CI: −1.74, −0.53; P < .001 vs Class I; 95% CI: −3.30, −2.09; P < .001 vs Class II) and total cranial base length (95% CI: −3.33, −1.36; P < .001 vs Class I; 95% CI: −7.38, −4.05; P < .001 vs Class II). Further, Class II patients showed significantly greater anterior and total cranial base length than did Class I patients (95% CI: 0.51, 1.87; P < .001 for SN; 95% CI: 2.20, 3.30; P < .001 for NBa). Cranial base angle was significantly smaller in Class III than in Class I (95% CI: −3.14, −0.93; P < .001 for NSBa; 95% CI: −2.73, −0.68; P  =  .001 for NSAr) and Class II malocclusions (95% CI: −5.73, −1.06; P  =  .004 for NSBa; 95% CI: −6.11, −1.92; P < .001 for NSAr) and greater in Class II than in Class I malocclusions (95% CI: 1.38, 2.38; P < .001 for NSBa).Conclusions:This meta-analysis showed that anterior and total cranial base length and cranial base angle were significantly smaller in Class III malocclusion than in Class I and Class II malocclusions, and that they were greater in Class II subjects compared to controls.     

Parents' preferences regarding appearance and attire of orthodontists

Objective:To evaluate parents'' preferences regarding the appearance and attire of orthodontists.Materials and Methods:Parents attending their child''s first orthodontic appointment were asked to choose from among sets of photographs of potential orthodontic providers. Selected factors were varied within the sets, including sex and age of the provider as well as attire (casual, formal, white coat, or scrubs), hairstyle (loose or tied back for women, facial hair or clean shaven for men), and presence of a nametag.Results:A total of 77 parents participated. There were significant differences in choice of provider in terms of the provider''s sex (P < .0001), age (P  =  .0013), dress (P < .0001), hair (P < .0001), and nametag (P  =  .0065). There were no significant differences in preference attributable to parent characteristics (P > .05).Conclusion:Parents of orthodontic patients demonstrated clear preferences for choosing a provider related to factors that are not within the control of the practitioner (sex and age) as well as factors that can be changed by the practitioner (attire, hairstyle, and wearing a nametag).     

Skeletal and dental effects of molar distalization using a modified palatal anchorage plate in adolescents

Objective:To evaluate and compare skeletal effects and the amount of molar distalization in maxilla using modified palatal anchorage plate (MPAP) vs headgear appliances in adolescent patients.Materials and Methods:Pre- and posttreatment lateral cephalograms of 45 Class II malocclusion patients were analyzed; 24 were treated with MPAP appliances (age, 12.4 years) and 21 with headgear (age, 12.1 years). Fixed orthodontic treatment started with the distalization process in both groups. Thirty-two variables were measured and compared between both groups using multivariate analysis of covariates.Results:There was no significant main effect of the appliance type on the treatment results (P  =  .063). Also, there was no significant main effect of the appliance type on both pre- and posttreatment comparisons (P  =  .0198 and .135, respectively). The MPAP and headgear groups showed significant distalization of maxillary first molars (3.06 ± 0.54 mm and 1.8 ± 0.58 mm, respectively; P < .001). Sagittal skeletal maxillomandibular differences were improved after treatment (P < .001), with no significant differences between the two groups. No significant difference in treatment duration was found between the groups.Conclusions:The MPAP showed a significant skeletal effect on the maxilla. Both MPAP and headgear resulted in distalization of maxillary first molars. Therefore, it is recommended that clinicians consider the application of MPAP, especially in noncompliant Class II patients.     

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.     

Long-term skeletal effects of high-pull headgear followed by fixed appliances for the treatment of Class II malocclusions

Objectives:The long-term skeletal effects of Class II treatment in growing individuals using high-pull facebow headgear and fixed edgewise appliances have not been reported. The purpose of this study was to evaluate the long-term skeletal effects of treatment using high-pull headgear followed by fixed orthodontic appliances compared to an untreated control group.Materials and Methods:Changes in anteroposterior and vertical cephalometric measurements of 42 Class II subjects (n = 21, mean age = 10.7 years) before treatment, after headgear correction to Class I molar relationship, after treatment with fixed appliances, and after long-term retention (mean 4.1 years), were compared to similar changes in a matched control group (n = 21, mean age = 10.9 years) by multivariable linear regression models.Results:Compared to control, the study group displayed significant long-term horizontal restriction of A-point (SNA = −1.925°, P < .0001; FH-NA = −3.042°, P < .0001; linear measurement A-point to Vertical Reference = −3.859 mm, P < .0001) and reduction of the ANB angle (−1.767°, P < .0001), with no effect on mandibular horizontal growth or maxillary and mandibular vertical skeletal changes. A-point horizontal restriction and forward mandibular horizontal growth accompanied the study group correction to Class I molar, and these changes were stable long term.Conclusions:One phase treatment for Class II malocclusion with high-pull headgear followed by fixed orthodontic appliances resulted in correction to Class I molar through restriction of horizontal maxillary growth with continued horizontal mandibular growth and vertical skeletal changes unaffected. The anteroposterior molar correction and skeletal effects of this treatment were stable long term.     

The perception of facial asymmetry using 3-dimensional simulated images

Objective:To investigate the perception of facial asymmetry in young adults to identify the amounts of chin asymmetry that can be regarded as normal and may benefit from correction.Materials and Methods:Three-dimensional (3D) images of 56 individuals of mixed ethnicity were obtained and used to produce average 3D images of male and female faces. Distortion was then applied to these average faces using a 3D graphics package to simulate different amounts of chin point asymmetry. Five observer groups (lay individuals, dental students, dental care professionals, dental practitioners, and orthodontists) assessed timed presentations of 3D images, rating them as “normal,” “acceptable,” or “would benefit from correction.” Time-to-event analysis was used to assess the level of chin asymmetry perceived as normal and beneficial for correction for each group.Results:The factors influencing the perception of facial asymmetry were the degree of asymmetry and the observer group. Direction of the asymmetry and gender of the assessed individual did not affect the perception of asymmetry, except in the 4- to 6-mm distortion range. The gender of the observer had no influence on perception. There were statistically significant differences in the amounts of asymmetry that the laypeople and orthodontists considered to be normal (5.6 ± 2.7 mm and 3.6 ± 1.5 mm, respectively; P < .001) and felt would benefit from surgical correction (11.8 ± 4.0 mm and 9.7 ± 3.0 mm, respectively; P  =  .001).Conclusions:Perception of asymmetry is affected by the amount of asymmetry and the observer group, with orthodontists being more critical.     

Interproximal reduction of teeth: Differences in perspective between orthodontists and dentists

Objective:To determine if interproximal reduction of teeth (IPR) is perceived differently by orthodontists and general dentists.Materials and Methods:A Web-based survey containing statements about IPR was developed and randomly distributed to orthodontists and general dentists.Results:The majority of orthodontists and general dentists strongly agreed that IPR is a minimally invasive procedure that poses little risk for the development of interproximal decay. However, general dentists were more likely to perform post-IPR polishing and to apply topical fluoride than are orthodontists (P < .0001). A greater percentage of orthodontists strongly believed that the esthetic and occlusal benefits of IPR outweigh the potential risk of tooth decay when IPR was performed (P < .0001). A greater percentage of general dentists were hesitant to perform IPR, despite research supporting that IPR has little negative effect on the health of teeth.Conclusions:The results of this study disproved the null hypothesis that orthodontists and general dentists share similar views regarding the use of IPR during orthodontic treatment. General dentists were more conservative in their views of IPR and were less comfortable with performing IPR as a routine procedure. General dentists felt more strongly about the importance of post-IPR polishing and application of topical fluoride. Orthodontists were more likely to have researched the long-term effects of IPR on the health of teeth and therefore felt more comfortable performing IPR during orthodontic treatment.     

Analysis of smile esthetics in American Board of Orthodontic patients

Objective:To investigate the common denominators of an esthetically pleasing smile in patients who were considered to be successfully treated upon the submission to American Board Orthodontics (ABO) clinical examination.Material and Methods:A total of 462 patients were examined. Ninety subjects that fulfilled the inclusion criteria were included. Standardized digital smile photographs of the subjects were rated by 30 panel members, including orthodontists, general dentists, and parents of orthodontic patients, using a numeric version of the visual analog scale. Three groups were formed using the mean esthetic score ± standard deviation range: unattractive (n  =  21), average (n  =  47), and attractive (n  =  22) smiles. Eleven smile characteristics were digitally measured on the photographs and compared between the groups using one-way analysis of variance and χ² tests. Additionally, regression analyses were used to investigate the association of the smile characteristics with the esthetic score.Results:A significant difference was found between the three groups for the comparison of smile arc relationship (P < .001). When all the variables used in this study were entered in the regression analysis, a positive association was found (r  =  0.658; r²  =  0.434; P < .001). Additionally, two models were defined using stepwise regression. The first model included the smile arc (r  =  0.478; r²  =  0.228; P < .001), and the second model had both the smile arc and right gingival display/visible dentition display ratio (r  =  0.567; r²  =  0.321; P < .001).Conclusions:A harmonious smile arc relationship and less gingival display during a smile are significantly associated with smile attractiveness in patients considered successfully treated according to ABO standards.     

The short-term treatment effects of face mask therapy in Class III patients based on the anchorage device: Miniplates vs rapid maxillary expansion

Objective:To compare the short-term treatment effects of face mask therapy with miniplates (FM-MP) and face mask therapy with rapid maxillary expansion appliance (FM-RME) in growing Class III malocclusion patients with maxillary hypoplasia.Materials and Methods:Twenty patients were allocated into two groups according to the anchorage device: FM-MP group (n  =  10; mean age  =  11.2 ± 1.2 years; miniplates in the zygomatic buttress area) and FM-RME group (n  =  10; mean age  =  10.7 ± 1.3 years; bonded or banded RME). The face mask was applied for 12 to 14 hours/day in both groups with a force of 400 g/side directed 30° downward and forward from the occlusal plane. Lateral cephalograms were taken before (T1) and after FM-MP or FM-RME therapy (T2). Skeletodental and soft-tissue variables were measured. Paired and independent t-tests were performed for statistical analysis.Results:Both groups exhibited significant forward movement of point A and posterior repositioning and opening rotation of the mandible from T2 to T1. The FM-MP group showed significant protraction of orbitale (ΔSNO), and the FM-RME group showed a decrease in overbite and an increase in Björk sum. Comparing the amount of changes between the two groups, the FM-MP group displayed greater forward movement of the maxilla than the FM-RME group (ΔSNA, ΔA to N perp, all P < .05). However, the FM-RME group exhibited a greater opening rotation of the mandible (ΔSNB, Björk sum, all P < .01; ΔPog to N-perp, P < .05) and labioversion of the maxillary incisors (ΔU1-FH, P < .05).Conclusion:FM-MP therapy induces a greater advancement of the maxilla, less posterior repositioning and opening rotation of the mandible, and less proclination of the maxillary incisors than FM-RME therapy.     

Effect of posterior impaction and setback of the maxilla on retropalatal airway and velopharyngeal dimensions after two-jaw surgery in skeletal Class III patients

Objective:To evaluate the changes in retropalatal airway and velopharyngeal dimensions after posterior impaction (PI) only or PI and setback (PI/SB) of the maxilla in patients with skeletal Class III undergoing two-jaw surgery.Materials and Methods:Subjects consisted of 60 Class III patients treated with two-jaw surgery. They were divided into two groups: group 1 (n  = 30; PI of the maxilla; mean  =  2.6 mm) and group 2 (n = 30; PI/SB of the maxilla; mean  =  2.8 mm and 1.8 mm, respectively). Using three dimensional computed tomography images taken 1month before surgery (T0) and at least 6 months after surgery (T1), retropalatal airway volume, minimum cross-sectional area, and lateral and anteroposterior (AP) dimensions of minimum cross-sectional area, soft palate angle, soft palate length, and pharyngeal depth were measured. A paired t-test and independent t-test were used for statistical analysis.Results:Group 1 showed increase in retropalatal airway volume and minimum cross-sectional area (P < .01 and P < .05, respectively). Group 2 exhibited decrease in retropalatal airway volume, minimum cross-sectional area, and lateral and AP dimensions of minimum cross-sectional area (all P < .01). Although groups 1 and 2 showed an increase in soft palate length (P < .01 and P < .001, respectively), pharyngeal depth significantly increased only in group 1 (P < .01). Groups 1 and 2 were significantly different in retropalatal airway volume, minimum cross-sectional area, and AP dimension (P < .05, P < .001, and P < .05, respectively).Conclusion:Because the direction of surgical movement in the maxilla can determine the changes in the retropalatal airway and velopharyngeal dimensions, it is recommended that clinicians investigate whether patients suffer from sleep-related breathing disorders before performing PI/SB of the maxilla.     

A retrospective study of Class II mixed-dentition treatment

Objective:To consider the effectiveness of early treatment using one mixed-dentition approach to the correction of moderate and severe Class II malocclusions.Materials and Methods:Three groups of Class II subjects were included in this retrospective study: an early treatment (EarlyTx) group that first presented at age 7 to 9.5 years (n = 54), a late treatment (LateTx) group whose first orthodontic visit occurred between ages 12 and 15 (n = 58), and an untreated Class II (UnTx) group to assess the pretreatment comparability of the two treated groups (n = 51). Thirteen conventional cephalometric measurements were reported for each group and Class II molar severity was measured on the study casts of the EarlyTx and LateTx groups.Results:Successful Class II correction was observed in approximately three quarters of both the EarlyTx group and the LateTx group at the end of treatment. EarlyTx patients had fewer permanent teeth extracted than did the LateTx patients (5.6% vs 37.9%, P < .001) and spent less time in full-bonded appliance therapy in the permanent dentition than did LateTx patients (1.7 ± 0.8 vs 2.6 ± 0.7years, P < .001). When supervision time is included, the EarlyTx group had longer total treatment time and averaged more visits than did the LateTx group (53.1 ± 18. 8 vs 33.7 ± 8.3, P < .0001). Fifty-five percent of the LateTx extraction cases involved removal of the maxillary first premolars only and were finished in a Class II molar relationship.Conclusion:EarlyTx comprehensive mixed-dentition treatment was an effective modality for early correction of Class II malocclusions.     

Tooth-borne vs bone-borne rapid maxillary expanders in late adolescence

Objective:To evaluate the immediate effects of rapid maxillary expansion (RME) on the transverse skeletal and dentoalveolar changes with bone-borne (C-expander) and tooth-borne type expanders using cone-beam computed tomography (CBCT) in late adolescents.Materials and Methods:A sample of 28 female late-adolescent patients was divided into two groups according to the type of expander: bone-borne (C-expander, n  =  15, age  =  18.1 ± 4.4 years) and tooth-borne (hyrax, bands on premolars and molars, n  =  13, age  =  17.4 ± 3.4 years). CBCT scans were taken at 0.2-mm voxel size before treatment (T1) and 3 months after RME (T2). Transverse skeletal and dental expansion, alveolar inclination, tooth axis, vertical height of tooth, and buccal dehiscence were evaluated on maxillary premolars and molars. Paired t-test, independent t-test, one-way analysis of variance, and Scheffé post hoc analysis were performed.Results:The C-expander group produced greater skeletal expansion, except in the region of the first premolar (P < .05 or < .01), which showed slight buccal tipping of the alveolar bone. The Hyrax group had more buccal tipping of the alveolar bone and the tooth axes, except in the region of the second molar (P < .05 or < .01 or < .001). Dental expansion at the apex level was similar in the banded teeth (the first premolar and the first molar). Vertical height changes were apparent on the second premolar in the hyrax group (P < .05 or < .01). Significant buccal dehiscence occurred at the first premolar in the hyrax group (P < .01 or < .001). There were no significant differences between tooth types for any variables in the C-expander group.Conclusions:For patients in late adolescence, bone-borne expanders produced greater orthopedic effects and fewer dentoalveolar side effects compared to the hyrax expanders.     

Bone- and dentoalveolar-anchored dentofacial orthopedics for Class III malocclusion: New approaches,similar objectives?: A systematic review

Objectives:To analyze the scientific literature and compare in the results of conventional orthopedic appliances with those obtained from recent bone-anchored orthopedics for Class III malocclusion.Materials and Methods:The literature was systematically reviewed using PubMed/Medline, Scopus, and Scirus databases up to January 2012. Articles were selected by two different researchers (kappa index  =  0.83), based on established inclusion/exclusion criteria. Methodologic quality was classified as high, medium, or low quality.Results:The search strategy identified 1020 titles. Thirty studies were selected after applying the criteria (high quality  =  9, medium quality  =  21). Protraction rates differed within a range of one- to twofold between bone-anchored and dentoalveolar therapies (P < .001). All studies noted the effect of clockwise rotation on the mandible and an increase in inferior-anterior and total facial height; this was more obvious in dentoalveolar therapy than in bone-anchored orthopedics (P < .001).Conclusions:Dental parameters like overjet increased significantly with both sets of groups, ranging from 1.7 to 7.9 mm with dentoalveolar therapy and from 2.7 to 7.6 mm with bone-anchored orthopedics.     

Quality of orthodontic treatment performed by orthodontists and general dentists: A blind comparative evaluation

Objective:To perform a blind comparative evaluation of the quality of orthodontic treatment provided by orthodontists and general dentists.Materials and Methods:Sixty cases of orthodontic treatment were evaluated—30 treated by specialists in orthodontics and 30 treated by general dentists with no specialization course. Orthodontists were selected randomly by lots, in a population of 1596 professionals, and recordings were performed based on the guideline established by the Objective Grading System proposed by the American Board of Orthodontics. Each participant was asked to present a case considered representative of the best outcome among the cases treated, regardless of the type or initial severity of the malocclusion. Statistical analysis involved the chi-square, Wilcoxon, and Mann-Whitney tests. The level of significance was set at P  =  .05 for the statistical tests.Results:The results showed that 29 orthodontists (96.7%) presented cases considered satisfactory and would be approved on the qualification exam, whereas only 15 dentists (50%) had cases considered satisfactory. Moreover, treatment time was significantly shorter among the orthodontists (P  =  .022), and the posttreatment comparison revealed that orthodontists achieved better outcomes considering all the variables studied.Conclusions:Orthodontists spend less time on treatment and achieve better quality outcomes than cases treated by general dentists who have not undergone a specialization course in orthodontics.