Journal of Orthodontics

To determine patient experience of pain during treatment with fixed orthodontic appliances, expectations of pain during debond and whether biting on a soft acrylic wafer during debond decreases pain experience.

Multicentre randomized controlled trial.

Three UK hospital based orthodontic departments: Mid-Staffordshire NHS Foundation Trust, Birmingham Dental Hospital and University Hospital of North Staffordshire.

Ninety patients were randomly allocated to either the control (n = 45) or wafer group (n = 45). A visual analogue scale-based questionnaire was completed pre-debond to determine pain experience during treatment and expectations of pain during debond. The appliances were debonded and those in the wafer group bit on a soft acrylic wafer. A second questionnaire was completed post-debond to assess the pain experienced.

Biting on an acrylic wafer significantly reduced the pain experienced when debonding the posterior teeth (P≤0·05). Thirty-nine per cent found the lower anterior teeth the most painful. The expected pain was significantly greater than that actually experienced (P≤0·0001). Greater pain during treatment correlated with increased expectations and increased actually experienced pain (P≤0·0001).

Biting on a soft acrylic wafer during debond of the posterior teeth reduces the pain experienced. The lower anterior teeth are the most painful. The pain expected is significantly greater than actually experienced. Patients who had greater pain during treatment expected and experienced greater pain at debond.

The main goal of this study was to optimize unilateral molar rotation correction by modifying a trans-palatal arch (TPA) design using the finite element method.

Three-dimensional analysis of different TPA designs was carried out using the finite element method.

Department of Orthodontics, Tehran University of Medical Sciences, Iran.

For this investigation, 13 three-dimensional finite element models were produced for different TPA designs without pre-activation bends. Each model contained a palatal bar and two tubes. Optimizing unilateral molar rotations was achieved by five separate different paths: incorporating U-loop(s), ‘R’ loop(s) or helix/helices, a reverse action of the helix/helices and adding a straight wire to the design. The mesial part of the left side tube was displaced 0·1, 0·25, 0·5 and 1 mm, successively towards the midline, simulating palatal bar tab engagement in a mesio-palatal rotated maxillary left molar. The mesio-distal force, moment and energy produced in the normal side (right) molar were recorded for each of the models.

Findings showed that in all designs, the associated mesializing force was lower than that seen in the traditional design and the moment showed an increasing pattern when compared with a simple palatal bar. Regarding energy levels, the same increasing pattern was observed in the designs between activations of 0·1 and 1·0 mm.

According to our optimized system, the TPA design with the highest energy and moment, but the lowest mesializing force associated with derotating a maxillary molar tooth was a parallel wire II design (i.e. adding a straight wire).

The purpose of this investigation was to undertake an objective and quantitative evaluation of how severity of lower anterior face height (LAFH) variations influences perceived attractiveness.

Cross-sectional study

St George's Hospital, London, UK

The LAFH of an idealized male and female frontal facial image were altered in 2·5 mm increments from −20 to 20 mm (male images) and from −10 to 20 mm (female images), in order to represent reduction and increase in height of this region. These images were rated by a pre-selected group of pre-treatment orthognathic patients (n = 75), clinicians (n = 35) and laypersons (n = 75).

Ratings on a seven-point Likert scale.

With an increase in LAFH, desire for surgery became significant at 15–16 mm for male faces and 13–14 mm for female faces. With a reduction in LAFH, desire for surgery became significant at −14 to −17 mm for male faces; a smaller reduction of −6 to −8 mm led to a significant desire for surgery for female faces.

The classical vertical facial trisection canon of upper face height as one-third (33·3%), midface height as one-third (33·3%) and LAFH as one-third (33·3%) of total anterior face height may be used as an ‘ideal’ proportional ratio. Mild LAFH variations were largely acceptable. In terms of the percentage LAFH to total anterior face height (TAFH) and anterior face height (AFH), observers did not desire surgery for LAFH variations of 25–42% of TAFH (40–66% of AFH) for male faces, and 28–42% of TAFH (45–66% of AFH) for female faces.

To evaluate preadolescent oral health related quality of life (OHRQoL) during the first month of fixed orthodontic appliance therapy.

Descriptive study.

The Department of Pediatric Dentistry and Orthodontics at Federal University of Minas Gerais, Belo Horizonte, Brazil.

This study included a sample of 96 preadolescent children aged between 11 and 12 years undergoing orthodontic treatment with a fixed appliance.

Preadolescent children were required to answer the short form of the Brazilian version of the Child Perceptions Questionnaire (CPQ_11–14) before treatment (T0) and 1 month after placement of the fixed appliance (T1). Statistical analysis was performed using the Wilcoxon signed rank test and the Bonferroni correction for the domains of CPQ_11–14.

Out of the 96 patients originally admitted, one gave up the treatment before the placement of bands and one failed to return the second questionnaire (T1). So, a sample of 94 preadolescents participated in this study, with a response rate of 97·9%. Among the 94 participants, 49 were females (52·1 %) and 45 were males (47·9 %). The mean age was 11·5 years (SD = 0·502). There was a statistically significant improvement in emotional well-being domain (P<0·001) as well as in the overall score (P = 0·032). However, there were no significant changes in oral symptoms, functional limitations and social well-being domains (P>0·013) before treatment and 1 month after the placement of fixed appliance.

One month after the placement of fixed orthodontic appliance, the preadolescents had positive alterations in their OHRQoL mainly in the emotional well-being domain.

To measure the reliability of tooth length measurements taken using dental pantomograms (DPT), long cone periapical radiographs (PR), and cone beam computed tomography (CBCT) and to compare their effective radiation dose.

A model containing sixteen anterior teeth was used to simulate a patient undergoing fixed appliance treatment. PRs were taken at standardized vertical angulations to the occlusal plane (0, 5, 10, 15, and 20°) using conventional and digital techniques. DPT and CBCT images were also taken. Measurements of radiation dosages were used to estimate a risk benefit analysis for each of the techniques.

DPT consistently overestimated tooth lengths by 2 mm or more [mean: 2·34 mm; 95% confidence interval (CI): 1·4–3·3 mm]. CBCT consistently underestimated tooth length (mean: −0·89 mm; 95% CI: −0·44 to −1·33 mm). PRs taken at 90° angulation closely resembled the actual tooth length (mean: −0·14 mm; 95% CI: −0·64 to 0·37 mm), but overestimation occurred with increasing PR film angulation. The radiation dosages ranged widely: DPT plus eight PRs that would be necessary to assess all teeth and root length of the upper and lower labial segments amounted to 23 μSv. Radiation dose from CBCT ranged from 17·8 to 60 μSv, depending on equipment and settings.

Determine the number of orthodontic randomized controlled trials (RCTs) published in four key orthodontic journals from 1 January 2001 to 31 December 2010, whether details about ethical approval (EA) and/or informed consent (IC) were reported and identify predictors for reporting EA and IC in orthodontic RCTs.

Retrospective observational study.

American Journal of Orthodontics and Dentofacial Orthopedics (AJODO), Angle Orthodontist (AO), European Journal of Orthodontics (EJO) and Journal of Orthodontics (JO) from 2001 to 2010.

AJODO, AO, EJO and JO were handsearched to identify all RCTs published from 1 January 2001 to 31 December 2010.

The RCTs were assessed to identify: inclusion of details about EA and IC, publication journal, number of authors, number and location of centres involved, perceived statistician involvement, publication year and inclusion of random* in either the title, abstract or body of the text.

218 RCTs were published. 109 (48·6%) had reported both EA and IC, 59 (27·1%) neither and 53 (12·9%) either EA or IC. Factors associated with an RCT reporting obtaining EA and IC: number of authors (P<0·001), random* in title (P<0·001), random* in abstract but not title (P<0·001), location of origin (P = 0·001), publication year (P = 0·003), journal of publication (P = 0·004) and number of centres (P = 0·008). Logistic regression suggested the most significant indicators of reporting EA and IC were: publication in the JO (P = 0·018), >6 authors (P<0·001), random* in the abstract but not title (P = 0·004) and publication after 2004 (P = 0·001).

RCTs were most likely to have reported EA and IC when published in the JO, after 2004 while having more than six authors and random* in the abstract but not title.

The increasing use of technology is rapidly changing our personal and professional lives. Smartphones allow users to access information in ways previously not possible and our patients may be accessing apps to source information about orthodontics and help them through their treatment.

To provide an overview of the orthodontic apps currently available on four of the main operating systems with emphasis on those apps targeted towards new and existing orthodontic patients as well as practising clinicians.

Four mobile devices were used to search four mobile operating systems (Android, Apple, Blackberry and Windows) using the key words ‘braces’, ‘orthodontist’, ‘orthodontic’ and ‘orthodontics’.

Android and Apple operating systems derived all of the apps considered relevant to orthodontic clinicians and patients. Clinician apps (11) related to orthodontic meetings (3), publications (3), products (3) and tooth ratio calculators such as Bolton (2). Patient apps (8) related to reminding patients about elastic wear (2) and aligner wear (2), dealing with orthodontic emergencies (2), orthodontic products (1) and a progress tracker of treatment (1).

Apps are available for both orthodontic clinicians and patients; however, much of the information contained within them is often not independent and even more often not validated. Patients are increasingly likely to access apps and clinicians should direct patients to those that are most appropriate and useful.