[Show abstract][Hide abstract] ABSTRACT: This review summarises updated clinical guidelines produced by the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS). This guideline on the management of the palatally ectopic maxillary canine illustrates the information contained in the recently updated online version. The timely recognition of ectopic canines is important for the overall management of the dentition. This review illustrates five management strategies for ectopic permanent canines: interceptive treatment by extraction of the deciduous canine, surgical exposure and orthodontic alignment, surgical removal of the palatally ectopic permanent canine, auto-transplantation and no active treatment/leave and observe. The current available evidence for each of these management options has been evaluated and awarded a grade used by the Scottish Intercollegiate Guidelines Network.
British dental journal official journal of the British Dental Association: BDJ online 08/2012; 213(4):171-6. · 1.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Our objective was to determine which factors were predictive of good long-term outcomes after fixed appliance treatment of Class II Division 1 malocclusion.
Two hundred seven patients with Class II Division 1 malocclusion were examined in early adulthood at a mean of 4.6 years after treatment with fixed appliances. The peer assessment rating index was used to evaluate dental alignment and occlusal relationships. The soft-tissue profile was assessed with the Holdaway angle.
Logistic regression identified 3 pretreatment variables that were predictive of a good facial profile (Holdaway angle) at recall: the lower lip to E-plane distance (P <0.001; smaller distance behind the E-plane means a better outcome), ANB angle (P = 0.001; smaller ANB means a better outcome), and extraction pattern (P = 0.026). Linear regression analysis showed that 2 pretreatment variables were predictive of a favorable PAR score at recall: SNB angle (P = 0.001; larger SNB means a better outcome) and extraction pattern (P = 0.034).
Three pretreatment cephalometric measures (lower lip to E-plane distance, ANB angle, and SNB angle) were predictive of the outcome in the treatment of Class II Division 1 malocclusion. The extraction pattern was also found to be a predictor of outcome.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 03/2011; 139(3):362-8. · 1.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To test the hypothesis that the self-perception of dental and facial attractiveness among patients requiring orthognathic surgery is no different from that of control patients.
Happiness with dental and facial appearance was assessed using questionnaires completed by 162 patients who required orthognathic treatment and 157 control subjects. Visual analog scale, binary, and open response data were collected. Analysis was carried out using a general linear model, logistic regression, and chi-square tests.
Orthognathic patients were less happy with their dental appearance than were controls. Class II patients and women had lower happiness scores for their dental appearance. Among orthognathic patients, the "shape" and "prominence" of their teeth were the most frequent causes of concern. Older subjects, women, and orthognathic patients were less happy with their facial appearance. Class III orthognathic patients, older subjects, and women were more likely to have looked at their own face in profile. A greater proportion of Class II subjects than Class III subjects wished to change their appearance.
The hypothesis is rejected. The findings indicate that women and patients requiring orthognathic surgery had lower levels of happiness with their dentofacial appearance. Although Class II patients exhibited the lowest levels of happiness with their dental appearance, there was some evidence that concerns and awareness about their facial profile were more pronounced among the Class III patients.
The Angle Orthodontist 03/2010; 80(2):361-6. · 1.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To establish the extent of psychological problems among patients who require orthognathic treatment.
Five aspects of psychological functioning were assessed for 162 patients who required orthognathic treatment and compared with 157 control subjects.
Analysis of variance did not detect any significant difference in the five psychological scores recorded for the skeletal II, skeletal III, and control groups. The proportion of subjects with one or more psychological measure beyond the normal range was 27% for skeletal II subjects, 25% for skeletal III subjects, and 26% for control subjects. One skeletal II subject (1.5%), three skeletal III subjects (3%), and five control subjects (3%) required referral for psychological counseling.
The orthognathic patients did not differ significantly from the control subjects in their psychological status.
The Angle Orthodontist 01/2010; 80(1):43-8. · 1.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: (1) to determine the opinion of parents regarding the psychosocial functioning of their child with cleft lip and/or palate (CLP); (2) to identify predictors of psychosocial functioning; and (3) to determine the level of agreement between children with CLP and their parents. Participants: One hundred twenty-nine parents of children with CLP and 96 parents of children without CLP participated in this cross-sectional study.
Parental opinion of the child's self-esteem, anxiety, happiness, and problems caused by facial appearance were assessed using visual analogue scales. Parents completed the Child Behavior Checklist and were interviewed.
Children with CLP were more anxious (p < 0.05), less happy with their appearance (p < 0.001), and in general (p < 0.05) had lower self-esteem (p < 0.05) and greater behavioral problems (p < 0.001) compared with non-CLP children. Parents reported that their child with CLP was teased more often (p < 0.001) and was less satisfied with his/her speech (p < 0.01) compared with reports of parents in the control group. A number of factors affected parents' ratings of their child's psychosocial functioning (presence of CLP, appearance happiness, previous history of CLP, and visibility of scar). Children who had been teased were more anxious (p < or = 0.01), less happy with their appearance (p < 0.001) and had greater behavioral problems (p < 0.001).
Parents of children with CLP reported various psychosocial problems among their children. Parents considered children who had been teased to have greater psychosocial problems.
The Cleft Palate-Craniofacial Journal 06/2007; 44(3):304-11. · 1.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Class II malocclusion is often associated with retrognathic mandible. Some of these problems require surgical correction. The purposes of this study were to investigate treatment outcomes in patients with Class II malocclusions whose treatment included mandibular advancement surgery and to identify predictors of good outcomes.
Pretreatment and posttreatment cephalometric radiographs of 90 patients treated with mandibular advancement surgery by 57 consultant orthodontists in the United Kingdom before September 1998 were digitized, and cephalometric landmarks were identified. Paired samples t tests were used to compare the pretreatment and posttreatment cephalometric values for each patient. For each cephalometric variable, the proportion of patients falling within the ideal range was identified. Multiple logistic regression analysis was performed to identify predictors of achieving ideal range outcomes for the key skeletal (ANB and SNB angles), dental (overjet and overbite), and soft-tissue (Holdaway angle) measurements.
An overjet within the ideal range of 1 to 4 mm was achieved in 72% of patients and was more likely with larger initial ANB angles. Horizontal correction of the incisor relationship was achieved by a combination of 75% skeletal movement and 25% dentoalveolar change. An ideal posttreatment ANB angle was achieved in 42% of patients and was more likely in females and those with larger pretreatment ANB angles. Ideal soft-tissue Holdaway angles (7 degrees to 14 degrees ) were achieved in 49% of patients and were more likely in females and those with smaller initial SNA angles. Mandibular incisor decompensation was incomplete in 28% of patients and was more likely in females and patients with greater pretreatment mandibular incisor proclination. Correction of increased overbite was generally successful, although anterior open bites were found in 16% of patients at the end of treatment. These patients were more likely to have had initial open bites.
Mandibular surgery had a good success rate in normalizing the main dental and skeletal relationships. Less ideal soft-tissue profile outcomes were associated with larger pretreatment SNA-angle values, larger final mandibular incisor inclinations, and smaller final maxillary incisor inclinations. The use of mandibular surgery to correct anterior open bite was associated with poor outcomes.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 02/2007; 131(1):7.e1-8. · 1.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In health care today there is a need to ensure that the advice given by orthodontists to patients and their parents is accurate and evidence-based. Historically, it has been claimed that orthodontic treatment may confer benefits beyond the psychosocial gains achieved by the improvement in dental appearance. Oral health-related benefits such as reduced susceptibility to dental caries, periodontal disease, temporomandibular disorder, and traumatic dental injury have been reported in the literature. However, this review of the literature reveals that the oral health benefits of orthodontic intervention are quite limited.
[Show abstract][Hide abstract] ABSTRACT: In this retrospective study, we investigated treatment outcomes in Class III surgical-orthodontic patients.
Records of 151 consecutively completed Class III surgical-orthodontic patients (overjet, 0 mm or less) were obtained from 87 consultant orthodontists in the United Kingdom. Pretreatment and posttreatment cephalometric radiographs were analyzed.
Bimaxillary surgical patients (75%) had more negative initial ANB-angle values and smaller initial SNA-angle values than those treated with single-jaw mandibular surgery. Mandibular surgery patients (15%) had greater pretreatment mandibular prominence (SNB angle) than maxillary patients. Maxilla-only patients (10%) had lower negative initial overjet values than bimaxillary patients. An overjet within the ideal range of 1 to 4 mm was achieved in 83% of the patients. Logistic regression identified no predictors of ideal overjet outcome. SNB angle was corrected to within the ideal range of 75 degrees to 81 degrees in 44% of the patients. This was less likely in those treated with maxillary surgery only and larger initial SNB-angle values. An ideal posttreatment ANB angle (1 degrees to 5 degrees) was achieved in 40% of the patients and was more likely in those with bimaxillary surgery, lower negative pretreatment ANB angles, and presurgical orthodontic extractions in the maxillary arch. Ideal posttreatment unadjusted Holdaway angles (7 degrees to 14 degrees) were achieved in 59% of the patients and were more likely when single-jaw mandibular surgery was used. Incisor decompensation was incomplete in 46% of the patients and was associated with mandibular arch extractions.
Surgical-orthodontic treatment had a high success rate in normalizing the overjet and soft-tissue profile to within ideal ranges in Class III patients. Bimaxillary surgery was the most frequently used procedure and was associated with an increased likelihood of an ideal correction of the anteroposterior skeletal discrepancy.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 10/2006; 130(3):300-9. · 1.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A cross-sectional study was employed to determine the psychosocial effects of cleft lip and/or palate among children and young adults, compared with a control group of children and young adults without cleft lip and palate.
The study comprised 160 children and young adults with cleft lip and/or palate and 113 children and young adults without cleft lip and/or palate. All participants were between 8 and 21 years of age.
Psychological functioning (anxiety, self-esteem, depression, and behavioral problems) was assessed using validated psychological questionnaires. Happiness with facial appearance was rated using a visual analog scale. Social functioning, including experience of teasing/bullying and satisfaction with speech, was assessed using a semistructured interview.
Participants with cleft lip and/or palate reported greater behavioral problems (p < .001) and more symptoms of depression (p < .01); they were teased more often (p < .001) and were less happy with their facial appearance (p < .01) and speech (p < .001), compared with controls. There were no significant difference between subjects with cleft lip and/or palate and subjects without cleft lip and/or palate in terms of anxiety (p > .05) or self-esteem (p > .05). Having been teased was a significant predictor of poor psychological functioning, more so than having a cleft lip and/or palate per se (p < .001).
Teasing was greater among participants who had cleft lip and/ or palate and it was a significant predictor of poorer psychosocial functioning. Children and young adults with cleft lip and/or palate require psychological assessment, specifically focusing on their experience of teasing, as part of their routine cleft care.
The Cleft Palate-Craniofacial Journal 09/2006; 43(5):598-605. · 1.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study investigated the influence of changing lower face vertical proportion on the attractiveness ratings scored by lay people.Ninety-two social science students rated the attractiveness of a series of silhouettes with normal, reduced or increased lower face proportions. The random sequences of 10 images included an image with the Eastman normal lower face height relative to total face height [lower anterior face height/total anterior face height (LAFH/TAFH) of 55 per cent], and images with LAFH/TAFH increased or decreased by up to four standard deviations (SD) from the Eastman norm. All the images had a skeletal Class I antero-posterior (AP) relationship. A duplicate image in each sequence assessed repeatability. The participants scored each image using a 10 point numerical scale and also indicated whether they would seek treatment if the image was their own profile. The profile image with normal vertical facial proportions was rated by the lay people as the most attractive. Attractiveness scores reduced as the vertical facial proportions diverged from the normal value. Images with a reduced lower face proportion were rated as significantly more attractive than the corresponding images with an increased lower face proportion. Images with a reduced lower face proportion were also significantly less likely to be judged as needing treatment than the corresponding images with an increased lower face proportion.
The European Journal of Orthodontics 09/2005; 27(4):349-54. · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This systematic review examined the published scientific research on the psychosocial impact of cleft lip and palate (CLP) among children and adults. The primary objective of the review was to determine whether having CLP places an individual at greater risk of psychosocial problems. Studies that examined the psychosocial functioning of children and adults with repaired non-syndromal CLP were suitable for inclusion. The following sources were searched: Medline (January 1966-December 2003), CINAHL (January 1982-December 2003), Web of Science (January 1981-December 2003), PsycINFO (January 1887-December 2003), the reference section of relevant articles, and hand searches of relevant journals. There were 652 abstracts initially identified through database and other searches. On closer examination of these, only 117 appeared to meet the inclusion criteria. The full text of these papers was examined, with only 64 articles finally identified as suitable for inclusion in the review. Thirty of the 64 studies included a control group. The studies were longitudinal, cross-sectional, or retrospective in nature.Overall, the majority of children and adults with CLP do not appear to experience major psychosocial problems, although some specific problems may arise. For example, difficulties have been reported in relation to behavioural problems, satisfaction with facial appearance, depression, and anxiety. A few differences between cleft types have been found in relation to self-concept, satisfaction with facial appearance, depression, attachment, learning problems, and interpersonal relationships. With a few exceptions, the age of the individual with CLP does not appear to influence the occurrence or severity of psychosocial problems. However, the studies lack the uniformity and consistency required to adequately summarize the psychosocial problems resulting from CLP.
The European Journal of Orthodontics 07/2005; 27(3):274-85. · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined the attractiveness of facial profiles. One hundred and two social science students (28 males and 74 females) rated the attractiveness of a series of silhouettes with normal, Class II or Class III profiles. A random sequence of 10 images included an image with the Eastman normal SNB value of 78 degrees, and images with SNB values of 2.5, 5, 7.5 and 10 degrees above and below normal. A duplicate image in each sequence was used to assess reproducibility. The participants scored the attractiveness of each image and also indicated whether they would seek treatment if each image was their own profile. The profile with the normal SNB angle of 78 degrees was rated as the most attractive. Attractiveness scores reduced as the mandibular profile diverged from the normal SNB value. The +5 degree profile (SNB = 83 degrees) was rated as significantly more attractive than the -5 degree profile (SNB = 73 degrees; P = 0.004). No other significant differences between the scores for Class II and Class III profile pairs of equal severity were found. At 10 degrees below the normal SNB (Class II), 74 per cent of the sample would elect to have treatment, while 78 per cent would elect to have treatment at 10 degrees above the normal SNB (Class III).
The European Journal of Orthodontics 05/2005; 27(2):129-33. · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study investigated the prevalence of bacteraemia on removal of fixed appliances. Venous blood samples were taken before and after debonding and debanding for 30 patients (mean age 17 years 8 months) who had worn fixed appliances for an average of 19 months. Before removal of the fixed appliances, bacteraemia was detected in one of the 30 subjects (3%) and in four subjects (13%) following removal of their fixed appliances. The 95 per cent confidence intervals for the prevalence of post-debanding bacteraemia were 3.8 and 30.7 per cent. No significant relationship was detected between the mean plaque scores (t = -0.65, P = 0.52) or the mean gingival scores (t = 0.75, P = 0.46) and the occurrence of bacteraemia. The prevalence of bacteraemia detected following debanding in this study is considerably lower than reported for dental procedures traditionally covered by antibiotic prophylaxis guidelines.
The European Journal of Orthodontics 09/2004; 26(4):443-7. · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The quality of outcomes in patients with unilateral cleft lip and palate (UCLP) was compared between two senior plastic surgeons. One surgeon carried out a one-stage Wardill-Kilner palate repair. The other surgeon employed a vomer flap hard palate repair followed by a von Langenbeck soft palate closure (Oslo protocol).
Thirty-four children (mean age 9.7 years) born with complete skeletal UCLP in Northern Ireland from 1983 to 1991 who received primary repair surgery from one of the two surgeons.
Cephalometric analysis was used to determine the craniofacial form and soft tissue profile. The quality of the dental arch relationships was independently assessed using the Goslon ranking system.
Twenty-nine of the 34 subjects had good or satisfactory arch relationships. Comparison between the surgeons revealed that the Wardill-Kilner group had a greater proportion of Goslon grades of greater than 3, indicating poor arch relationships. However, this difference failed to reach statistical significance. There were no significant cephalometric differences between patients treated by the two surgeons.
Although the difference was not statistically significant, the highest proportion of patients likely to require orthognathic surgery was found in those treated using the Wardill-Kilner technique.
The Cleft Palate-Craniofacial Journal 02/2004; 41(1):42-6. · 1.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study compared the use of horizontal parallax (HP) and vertical parallax (VP) radiography for localizing ectopic maxillary canines (EMCs). The true positions of 43 EMCs were determined using the operative notes and subsequent study models following exposure and eruption. Thirty-four palatal and nine buccal EMCs were included in the study. Six experienced orthodontists examined the radiographs of the EMCs and were asked to localize each EMC using VP and HP on separate occasions. The examiners recorded a diagnosis of 'unsure' in 12 per cent of cases using VP and in 5 per cent of cases using HP. The level of agreement of the diagnoses with the true position of the EMCs was significantly greater for HP. Eighty-three per cent of EMCs were correctly located with HP while only 68 per cent were correctly located with VP (P < 0.05). The diagnostic sensitivity for palatally placed canines was significantly greater for HP (88 per cent) than for VP (69 per cent). Both techniques performed poorly when used to localize buccal EMCs, with HP and VP each having a sensitivity of only 63 per cent. It is concluded that HP is superior to VP in diagnostic accuracy, and that two peri-apical radiographs or one peri-apical and one anterior occlusal radiograph are the radiographs of choice for localizing EMCs.
The European Journal of Orthodontics 12/2003; 25(6):585-9. · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Photo-elastic models replicating a lower arch with a moderate degree of lower incisor crowding and a palatally displaced maxillary canine were used to evaluate the stresses transmitted to the roots of the teeth by initial alignment archwires. Six initial alignment archwires were compared, two multi-strand stainless steel wires, two non-super-elastic (stabilized martensitic form) nickel titanium wires, and two stress-induced super-elastic (austenitic active) nickel titanium wires. Three specimens of each archwire type were tested. Analysis of the photo-elastic fringe patterns, in the medium supporting the teeth, revealed that the non-super-elastic nickel titanium archwires produced the highest shear stresses (P = 0.001). However, the shear stresses generated by the super-elastic alignment archwires and the multi-strand stainless steel archwires were very similar (P = 1.00). These results show that even in situations where large deflections of initial alignment archwires are required, super-elastic archwires do not appear to have any marked advantage over multi-strand stainless steel alignment archwires in terms of the stresses transferred to the roots of the teeth.
The European Journal of Orthodontics 05/2003; 25(2):117-25. · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the role of the anti-inflammatory neuropeptide vasoactive intestinal peptide (VIP) in periodontal health and disease and to determine the effects of periodontal treatment, resulting in a return to periodontal health, on the levels of VIP in gingival crevicular fluid (GCF).
At baseline, 10 subjects with periodontitis (nine females, one male, mean age 43.0, SD 7.3) started a course of non-surgical periodontal treatment. Clinical indices were measured at one periodontitis and one clinically healthy site at an initial visit and at 8 weeks after the completion of treatment in each subject. A 30-s sample of GCF was collected from each test site using perio paper strips. The volume of GCF was measured and each sample subsequently analysed for VIP by radioimmunoassay. One healthy site was sampled from each member of a control group (10 females, mean age 29.9, SD 8.2 years) with clinically healthy gingiva and no periodontitis.
The clinical condition of all periodontitis sites improved as a result of periodontal treatment. The levels of VIP (pg/30 s sample) in periodontitis-affected sites fell significantly from 302.0 (SD 181.2) at the initial visit to 78.0 (54.4) after treatment, p = 0.007. The reduction in the concentration of VIP (pg/ micro L) in GCF from 524.3 (322.3) to 280.8 (280.2) was not statistically significant. The levels of VIP in clinically healthy sites fell from 115.5.5 (74.3) to 77.8 (32.3), n.s. and the concentration changed little from 883.8 (652.1) to 628.7 (323.3), n.s. There were substantially smaller amounts of VIP (25.8, SD 12.8) pg in healthy sites sampled from control subjects.
VIP is present in GCF in greater quantities in periodontitis-affected than clinically healthy sites. In addition, the reduction in inflammation resulting from effective periodontal treatment is associated with a reduction in the levels of VIP in gingival crevicular fluid.
Journal Of Clinical Periodontology 07/2002; 29(6):484-9. · 3.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This randomized placebo-controlled cross-over trial assessed the effectiveness of a mandibular advancement appliance (MAA) in managing obstructive sleep apnoea (OSA). Twenty-one adults, with confirmed OSA, were provided with a maxillary placebo appliance and a MAA for 4-6 weeks each, in a randomized order. Questionnaires at baseline and after each appliance assessed bed-partners' reports of snoring severity (loudness and number of nights per week), and patients' daytime sleepiness (Epworth Sleepiness Score, ESS). The Apnoea Hypopnoea Index (AHI) and Oxygen Desaturation Index (ODI) were measured at baseline and with each appliance during single night sleep studies. Seventy-nine per cent of subjects wore their MAA for at least 4 hours at night. Sixty-eight per cent of subjects wore their MAA for 6-7 nights per week. Excessive salivation was the most commonly reported complication. One subject was unable to tolerate the MAA and withdrew from the study. Among the remaining 20 subjects, the MAA produced significantly lower AHI and ODI values than the placebo. However, although the reported frequency and loudness of snoring and the ESS values were lower with the MAA than the placebo, these differences were not statistically significant. When wearing the MAA, 35 per cent of the OSA subjects had a reduction in the pre-treatment ODI to 10 or less, while 33 per cent had an AHI of 10 or less. The MAA was less effective in the subjects with the most severe OSA (pre-treatment ODI > 50 and/or pre-treatment AHI > 50).
The European Journal of Orthodontics 06/2002; 24(3):251-62. · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined the influence of maxillary gingival display on the attractiveness ratings awarded by lay people. One hundred and twenty university students (94 females, 26 males) were shown seven photographs of a male and seven photographs of a female subject, each with varying levels of gingival display ranging from -2 to +4 mm. Attractiveness ratings were recorded on a 10-point numerical scale for each of the photographs. The photographs where the full height of the incisors were revealed and no gingival tissue was visible (0 mm of gingiva) were rated as the most attractive. Gingival display of more than 2 mm was rated as progressively less attractive. Linear regression analysis revealed that those students who had received orthodontic treatment rated the photographs representing the female student as more attractive than those representing the male (P < 0.05).
The European Journal of Orthodontics 05/2002; 24(2):199-204. · 1.08 Impact Factor