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Oral Health-Related Benefits of Orthodontic Treatment
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.
... 3,6-10 2-In general, the evidence for harmful effects of deviant occlusal traits on oral health is lacking; orthodontists do not claim to prevent caries, periodontal disease, dental trauma, and temporo-mandibular disorders. [16][17][18][19][20][21][22] 3-Determining the cut-off point beyond which a malocclusion becomes abnormal and induces a pathological function is difficult. 12,22 4-There is no evidence-based method of quantification for malocclusion, i.e., how occlusal traits should be scored and weighted relative to one another? ...
... Dental trauma has a multi-factorial aetiology and the incidence decreases with age. 16,48 The selected cut-off points for overjet in OTNI may be barely related to some cross-sectional studies [48][49][50][51][52][53][54][55][56] (Table 4). The Index of Orthodontic Treatment Need (IOTN) 33 classifies all individuals with an overjet greater than 6 mm into the great need category. ...
... Contrary to this prevalent belief, cross-sectional 18,19,79,80 and longitudinal 81 studies have not shown a link between dental caries and either tooth irregularity or DC; orthodontists do not claim to prevent caries by orthodontic intervention. 16 However, this relationship can be different in people of low social status. 11 Excessive overjet 82 and DC 79,83-86 have been associated with gingivitis and an increased amount of plaque build-up, but exploring the link between DC and periodontal diseases resulted in conflicting findings. ...
To date, there is no evidence-based method of quantification for malocclusion. Consequently, how deviant occlusal traits should be scored and weighted relative to one another is a matter of serious debate. Orthodontic Treatment Need Indices (OTNI) use the subjective opinion of the experts, as their foundation, to define the pathological boundaries (cut-offs) of occlusal traits. This paper reviews the evidence relating malocclusions or deviated occlusal traits to oral health problems, and investigates if this evidence supports the cut-off points and the rationale used for OTNI.
The relevant cited studies and reviews from the MEDLINE, Web of Science, Scopus, Cochrane databases, and scientific textbooks were used. The citation rate was confirmed by using the Google Scholar.
So far, the evidence for harmful effects of deviated occlusal traits on oral health is either lacking or exists as cross-sectional (mostly) and longitudinal (a few and primarily short-term) studies. When an association was reported between a deviated occlusal trait and an oral health problem, either the strength of that association was weak, or due to methodological issues, findings were not conclusive. Consequently, establishing a cause and effect relationship is difficult. Further, commonly used OTNI do not record a full spectrum of occlusal traits, and relating their ranking or scoring systems to the available evidence is difficult. Therefore, there is little evidence to suggest that individuals with a high need (high score), as measured by OTNI, will necessarily put at risk their oral health if they turn down orthodontic therapy.
OTNI have a role in the epidemiology and can be used for resource planning, but their predictive value to detect the future objective functional deficits or oral health problems is questionable. OTNI will need revalidation overtime with emerging research findings.
... In this regard, the orthodontic indices have considerably helped standardization of the orthodontic care assessment [1]. Today, there is an increasing preference toward the use of numerical crite-ria or indices for the objective scoring of malocclusions in order to determine their difficulty grades and assess the treatment outcomes [2]. The occlusal indices, such as index of orthodontic treatment need (IOTN) [3] and dental aesthetic index (DAI) [4], have been successfully used in various countries and provided valuable information about the orthodontic treatment need [5][6]. ...
... J Dent Shiraz Univ Med Sci., June 2019; 20(2): 95-101. ...
Statement of the problem:
Effective and informed planning for orthodontic services in any population requires assessment of the orthodontic treatment need and complexity.
Purpose:
The present cross-sectional study was conducted to assess these parameters using index of complexity, outcome, and need (ICON) in an Iranian schoolchildren population.
Materials and method:
In total, 600 randomly selected individuals (300 girls, 300 boys; aged 13-15 years) participated in this study. The treatment need (ICON score>43) and the grades of complexity were compared between two genders and in different age groups. Descriptive statistics and Chi-square test were applied for data analysis considering p< 0.05.
Results:
Out of 45% of the population found in need for orthodontic treatment, there was no significant difference between the two genders, but the 15-year-old individuals needed treatment significantly more than the individuals with 13 and 14 years of age. The mean ICON score was 44.3±20.28, which showed no significant difference between the two genders. The majority of the cases (34%) were categorized in the easy compartment in terms of complexity and 18% had difficult or very difficult grades of complexity. The genders and age groups exhibited no significant difference in terms of the complexity grade.
Conclusion:
Although half of the studied cases needed treatment, nearly one-fifth had difficult or very difficult complexity grade, which indicates the need for specialist care.
... In 2011, 60 percent of Dutch adolescents were reported to have had orthodontic treatment during childhood (1). However, how orthodontic treatment need is defined and the general health benefits of treatment are still ambiguous (2). Inconclusive results may be due to a general lack of orthodontic research on this topic or the use of improper outcome measures (3). ...
... Finally, the question addresses a topic that is very important to orthodontics. For a long time, aesthetics has been suggested to be one of the major reasons to seek and provide orthodontic treatment in addition to oral function (2,9). When the COHIP-ortho is administered to the children themselves, the reliability of the item might increase because they simply do know themselves better. ...
Oral health-related quality of life (OHRQOL) is currently assessed by long questionnaires, which limits its applicability as an outcome measure in orthodontic practice and research. The aim of the study was to evaluate a shortened measure with a low response burden for assessing OHRQOL in children.
A cross-sectional study of 243 prospective orthodontically treated children (12 percent cleft lip, 68 percent with definite objective treatment need, 20 percent borderline objective treatment need) collected data on OHRQOL using the 38-item version of the Child Oral Health Impact Profile (COHIP-38) and general health perception (GHP), and subjectively and objectively measured orthodontic treatment need. Eleven items of the COHIP-38 were selected for the short version of the questionnaire (COHIP-ortho). Score distributions, internal consistency, construct and criterion validity, as well as subgroup analysis were used to evaluate the psychometric properties of both questionnaires. The performances of COHIP-ortho and COHIP-38 were compared.
The internal consistency was somewhat lower for the COHIP-ortho compared with the COHIP-38, but on an acceptable level for both questionnaires. The correlations between COHIP-ortho scores and COHIP-38 overall as well as subscale scores were excellent. COHIP-ortho performed adequately regarding construct and criterion validity related to most sample characteristics compared with the performance of the COHIP-38.
The COHIP-ortho is as valid as the COHIP-38 for assessing OHRQOL in children. With a low response burden for patients or study participants, reduced cost, and less time needed for administration, the COHIP-ortho simplifies the investigation of OHRQOL in orthodontics.
© 2015 American Association of Public Health Dentistry.
... 27 Thus, a persistent different tongue kinematic profile during childhood may affect not only the development of tongue-jaw coordination but also of dental occlusion 20 because of the effect of tongue and lip pressure on the position of the teeth, 28 considering that tongue functions and kinematics work together with the upper and lower jaws' growth and dental occlusion morphology. 20 In general, the cause and effect relationship between malocclusion and oral or psychological health is either nonexistent or considered weak 29,30 and there are many areas that have not been investigated yet. As such, the putative correlation between learning disabilities and malocclusion has not yet been considered in clinical practice, as far as we are aware, even though a recent report pinpointed that a multi-component model of language abilities would best explain the relationship between specific language impairment and DD and the different profiles of impairment that could be observed. ...
... Even if the relationship between malocclusion and psychological health could be considered as presumptive and debated, 29,30,65,66 this preliminary study may shed light on part of this unexplored area. ...
The objective of the study reported here was to assess the orthodontic features in children affected by developmental dyslexia (DD).
A total of 28 children affected by DD (22 boys, six girls; mean age: 9.78 ± 1.69 years) were compared with 51 healthy children (38 boys, 13 girls; mean age 9.41 ± 1.48; range 7-10 years). Reading and writing skills were evaluated along with orthodontic features.
The DD and control groups were not significantly different in terms of total intelligence quotient (P = 0.441) and writing skills (P = 0.805 and P = 0.240, respectively), whereas significant differences were observed between the DD group and control group in both word reading (2.018 ± 1.714 vs 0.917 ± 0.563; P = 0.000) and non-word reading (2.537 ± 1.543 vs 0.862 ± 0.244; P = 0.000). Moreover, for many orthodontic features, there was no significant difference between the two groups; only in prevalence of diastemas (57.14%, P = 0.006), midline diastemas (46.42%, P = 0.007), overbite > 4 mm (71.42%, P = 0.006) and overjet > 4 mm (53.57%, P = 0.001), was there a statistically significant difference. According to univariate logistic regression analysis, the presence of diastemas (odds ratio [OR] 4.33; 95% confidence interval [CI] 1.61-11.65), midline diastemas (OR 4.68; 95% CI 1.61-13.43), an overbite >4 mm (OR 1.75; 95% CI 0.64-4.71), or an overjet >4 mm (OR 2.76; 95% CI 1.06-7.20) seems to play a role in the relationship between occlusal abnormalities and DD in children.
Children with DD tend to present with altered dental features, particularly in the area of the incisors, suggesting that a persistently different tongue kinematic profile may thus affect both the developmental variability of the tongue and lip and the occlusion.
... A recent systematic re-view has shown that some psychological and physical conditions that occur following TMD that reduce the quality of life and also functional limitations associated with pain can lead to psychological and physical disabilities in addition to social disabilities [16]. Health is a factor when evaluating the quality of life, and the actual impact of health and diseases on quality of life is referred to as Oral Health-Related Quality of life (OHRQoL) [17]. According to Locker (the founder of the OHRQoL), OHIP-14 is an appropriate tool in terms of involving different aspects of OHRQoL compared to other similar questionnaires [18]. ...
Objective: The study aims to evaluate the oral health index related to the quality of life in patients with temporomandibular disorder (TMD) referred to the Mashhad School of Dentistry between 2018 and 2019 before and three months after treatment. Methods and materials: This observational prospective study was conducted by interviewing patients with temporomandibular joint (TMJ) pain and clicking who referred to the Department of Prosthodontics, Mashhad Dental School, Iran, between 2018 and 2019. The demographic information of 63 patients was recorded separately. Then, using the Persian version of the OHIP-14 and GHQ-28 questionnaire, the quality of life in patients with TMD was compared before and three months after stabilization splint treatment. To evaluate the quality of life, the OHIP-sum index was used, and finally, the obtained data were analyzed by SPSS software using the Mann-Whitney test, paired-sample t-test, and Wilcoxon test. Results: OHIP sum was 24.31±8.82 and 13.15±9.52, before and after the intervention respectively. The GHQ sum was 33.32±12.9 and 20.71±11.07 before and after the intervention respectively, showing a significant decrease. The most problems of the stabilization splint users were related to psychological discomfort and the least common problems were related to functional limitations. Conclusion: The treatment of TMD using stabilization splints can significantly increase the oral health-related quality of life (OHRQoL) in these patients.
... There are assertions regarding the potential long-term influence of facial features, particularly oral aesthetics, on psychological health (Borzabadi-Farahani, 2012). This influence seems to be particularly pronounced during life phases characterized by intense social and emotional interactions (Burden, 2007). A review of four high-quality studies established that individuals with malocclusion experienced adverse effects on their emotional and social well-being (Dimberg et al., 2015). ...
... Orthodontics is becoming extensively popular as the most efficient and simplest treatment method for teeth restoration. Orthodontics can not only prevent teeth from oral problems (including periodontitis, caries, tooth loss, etc.), but also can achieve the effect of teeth whitening and improve the self-confidence of patients (Burden, 2007;Chaturvedula et al., 2021). At present, compared with traditional orthodontics, invisible orthodontics (IO) has gradually become the mainstream with its advantages of aesthetics comfort and ease of use. ...
In virtue of the advantages, such as aesthetics, designability, convenient removal, and comfortable experience, invisible orthodontics (IO) have been widely recognized and accepted by the public. However, most of the membranes currently used for IO only meet the requirement of shape retention. Other vital functions, like antibacterial and antifouling activities, are neglected. Herein, antibacterial composite membranes (ACMs) containing polypropylene (PP), thermoplastic polyurethane (TPU) and poly (hexamethylene guanidine) hydrochloride-sodium stearate (PHMG-SS) were facilely manufactured through the hot-pressing membrane forming technology. ACMs were conferred with favorable transparency (∼70% in the visible light range) and excellent antibacterial ability. Experiment results demonstrated that bactericidal rates of ACMs against Staphylococcus aureus, Escherichia coli and Streptococcus mutans were larger than 99.99%. Noticeably, the amount of protein adhered on the surface of ACMs was only 28.1 μg/cm², showing ideal antifouling performance. Collectively, the mutifunctional ACMs in the study are expected to be prominent alternatives for existing IO.
... [4] Despite the inadequacy of evidence linking psychosocial well-being to tooth malalignment, it has been proven that self-perception has an impact on facial traits, including oral esthetics. [5] In older teens and young adults, physical attraction has a considerable impact on colonial interactions and self-perception, which can impact their quality of life significantly. [6][7][8] This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. ...
Malocclusion has been linked to various factors out of which certain dietary patterns and unhealthy habits are the most overlooked. The dietary patterns and unhealthy habits vary according to socioeconomic status. The present research was aimed to perform an association of malocclusion severity with socioeconomic status. This study was done in a retrospective manner and was conducted at Saveetha Dental College. A total of 241 clinical case records of the participants with malocclusion reporting for orthodontic therapy were selected and enrolled for the study. Data on the socioeconomic status and the severity of malocclusion as assessed with the Index of Orthodontic Treatment Needs (IOTNs) index were noted. All these records were collected and entered into Excel and then analyzed through statistics. Descriptive statistics and nonparametric Chi-square tests were performed. From the analysis, the proportion of IOTN Grade 1 malocclusion (30%) was found to be the highest. The highest number of patients with Grade 1 malocclusion belonged to the lower socioeconomic class. Socioeconomic status and the severity of malocclusion were significantly associated with each other. Malocclusion prevalence and severity were more among participants belonging to lower socioeconomic groups.
... With improved alignment, teeth cleaning would be easier, thus reducing the occurrence of caries and periodontal diseases (Hunt et al., 2001). Well-aligned teeth can also decrease the risk of grinding, chipping of teeth and injury from accidents with protruding teeth (Burden, 2007). ...
Purpose
Clear thermoplastic aligners have become popular in orthodontics, but the biomechanics of these devices is not well understood. Neither is the tooth movement induced by such devices. The aim of this study was to develop and validate finite element (FE) models for clear thermoplastic teeth aligners for orthodontic force prediction.
Methods and materials
FE models were created from Micro-CT scans of an aligner and a model arch of teeth with one of the incisors tipped buccal-lingually by 2.4°. The models were uniformly meshed with 0.3-mm long elements. Linear-elastic mechanical properties provided by the material manufacturers were used. Fitting of the two components was simulated using Abaqus's interference fit, followed by frictional surface-to-surface interaction. The assembled FE model was validated by comparing its prediction for the teeth-aligner gaps and aligner surface strains with experimental data. The experimental teeth-aligner gaps were obtained from the Micro-CT scans whereas the aligner surface strains were measured using a 2-camera digital image correlation (DIC) system.
Results
Good agreement between prediction and measurement was obtained for both the teeth-aligner gaps and aligner surface strains. The linear regression between prediction and measurement for teeth-aligner gaps sampled at different positions had a R² value of 0.99. The mean difference between prediction and measurement for the aligner surface strains (von Mises) over 1544 nodes on the labial side and 1929 nodes on the lingual side was 0.07% and 0.01%, respectively, both being lower than the mean background noise.
Conclusion
A FE model for clear thermoplastic teeth aligners has been successfully developed and validated. The model can therefore be used with confidence to predict the forces and moments applied to teeth by the aligners, thus improving our understanding of the biomechanics of such devices and the tooth movement they induce.
... One main reason for orthodontic treatment is a significant improvement in the dental and facial aesthetic. The significance of orthodontic treatment is tough to justify if treatment is founded on improvement in dental or oral health for the majority of orthodontic patients [10]. Studies published in the past demonstrated an amplified awareness of the psychosocial advantage of orthodontic treatment [11]. ...
The purpose of the present study was to assess the characteristics of malocclusion and determine the orthodontic treatment needs of a group of children with Down syndrome. The study group comprised 23 children aged 10–14 years with Down syndrome who were attending special schools. A clinical examination was performed to measure several parameters that assessed malocclusion as well as classifications based on the Index of Orthodontic Treatment Need (IOTN- DC). When the dental health component (DHC) of the IOTN-DC was considered, results showed that a high percentage of children involved in the current study needed orthodontic treatment (81.9%). Moreover, 59.1% showed Angle’s class-III malocclusion compared to 36.4% who showed class I. However, the differences between the IOTN-DC values for the boys and girls were not statistically significant (p > 0.05). The present study has concluded that a higher percentage of children, suffering from Down syndrome, had very severe malocclusion; therefore, treatment can be considered mandatory. Similarly, more than three-fourths of the children with Down syndrome had visited a dental clinic at least once during their life. However, 30.4% of the children’s mothers have mentioned that they had not visited any orthodontic clinic. Therefore, there is a need to develop awareness and knowledge among the parents of children suffering from Down syndrome.
... Malocclusion has been considered to be highly prevalent and can affect oral and facial aesthetics as well as psychosocial wellbeing in the long term (Borzabadi-Farahani, 2012;Vellappally et al., 2014). It was claimed that the facial features, especially oral aesthetics, had the potential to influence self-perceived appearance, especially during the phase of life with intense social and affective interaction (Burden, 2007). Patients seeking orthodontic treatment aim to improve their dental aesthetics and facial balance (Turley, 2015;Singh et al., 2021). ...
Objectives: Machine learning is increasingly being used in the medical field. Based on machine learning models, the present study aims to improve the prediction performance of craniodentofacial morphological harmony judgment after orthodontic treatment and to determine the most significant factors.
Methods: A dataset of 180 subjects was randomly selected from a large sample of 3,706 finished orthodontic cases from six top orthodontic treatment centers around China. Thirteen algorithms were used to predict the value of the cephalometric morphological harmony score of each subject and to search for the optimal model. Based on the feature importance ranking and by removing features, the regression models of machine learning (including the Adaboost, ExtraTree, XGBoost, and linear regression models) were used to predict and compare the score of harmony for each subject from the dataset with cross validations. By analyzing the prediction values, the most optimal model and the most significant cephalometric characteristics were determined.
Results: When nine features were included, the performance of the XGBoost regression model was MAE = 0.267, RMSE = 0.341, and Pearson correlation coefficient = 0.683, which indicated that the XGBoost regression model exhibited the best fitting and predicting performance for craniodentofacial morphological harmony judgment. Nine cephalometric features including L1/NB (inclination of the lower central incisors), ANB (sagittal position between the maxilla and mandible), LL-EP (distance from the point of the prominence of the lower lip to the aesthetic plane), SN/OP (inclination of the occlusal plane), SNB (sagittal position of the mandible in relation to the cranial base), U1/SN (inclination of the upper incisors to the cranial base), L1-NB (protrusion of the lower central incisors), Ns-Prn-Pos (nasal protrusion), and U1/L1 (relationship between the protrusions of the upper and lower central incisors) were revealed to significantly influence the judgment.
Conclusion: The application of the XGBoost regression model enhanced the predictive ability regarding the craniodentofacial morphological harmony evaluation by experts after orthodontic treatment. Teeth position, teeth alignment, jaw position, and soft tissue morphology would be the most significant factors influencing the judgment. The methodology also provided guidance for the application of machine learning models to resolve medical problems characterized by limited sample size.
... Most patients with malocclusion seek treatment to improve esthetics, psychosocial relationships, and the quality of life (QOL) [1]. However, orthodontic treatment could also improve oral functions and oral health [2,3]. Demand for orthodontic treatment and treatment outcome satisfaction is not necessarily in correlation with the objective malocclusion records and the clinician's opinion [4]. ...
SUMMARY
Introduction/Objective This study aimed to translate the original disease-specific Malocclusion Impact
Questionnaire (MIQ) into Serbian and validate the new version in the cohort of young Serbian orthodontic
patients.
Methods At the university clinic, 154 patients filled out the MIQ in Serbian before the start of the orth�odontic treatment; 112 participants filled out the same questionnaire four weeks later. The Index of
Orthodontic Treatment Need – Dental Health Component (IOTN-DHC) and Peer Assessment Rating (PAR)
pretreatment scores were recorded. Descriptive statistic, Cronbach’s α, Spearman’s ρ, and exploratory
factor analysis, followed by parallel analysis for factor reduction, were calculated and analyzed.
Results One hundred forty-eight patients with no missing responses (51 male, 97 female), of the average
age of 13.3 ± 2 years, had MIQ total scores mean of 10.14 ± 7.451. Internal reliability (α = 0.913), external
reliability (ρ = 0.906; p = 0.000), construct validity tested by MIQ total scores and two global question
scores’ correlations (ρ = 0.682; p = 0.000 and ρ = 0.366; p = 0.000), as well as clinical validity tested by
correlations of MIQ total scores with PAR pretreatment scores (ρ = 0.181; p < 0.05), and IOTN-DHC scores
(ρ = 0.192; p < 0.05) were positive and statistically significant. One item factor was extracted and it ex�plained a large part of the cumulative variance.
Conclusion Reliability and validity of the translated and cross-culturally adapted MIQ in Serbian is satisfac�tory. It could be used for malocclusion-related quality of life assessments in young Serbian orthodontic
patients.
Keywords: MIQ,
... One main reason for orthodontic treatment is a significant improvement in the dental and facial aesthetic. The significance of orthodontic treatment is tough to justify if treatment is founded on improvement in dental or oral health for the majority of orthodontic patients [10]. Studies published in the past demonstrated an amplified awareness of the psychosocial advantage of orthodontic treatment [11]. ...
The purpose of the present study was to assess the characteristics of malocclusion and determine the orthodontic treatment needs of a group of children with Down syndrome. The study group comprised 23 children aged 10–14 years with Down syndrome who were attending special schools. A clinical examination was performed to measure several parameters that assessed malocclusion as well as classifications based on the Index of Orthodontic Treatment Need (IOTN-DC). When the dental health component (DHC) of the IOTN-DC was considered, results showed that a high percentage of children involved in the current study needed orthodontic treatment (81.9%). Moreover, 59.1% showed Angle’s class-III malocclusion compared to 36.4% who showed class I. However, the differences between the IOTN-DC values for the boys and girls were not statistically significant (p > 0.05). The present study has concluded that a higher percentage of children, suffering from Down syndrome, had very severe malocclusion; therefore, treatment can be considered mandatory. Similarly, more than three-fourths of the children with Down syndrome had visited a dental clinic at least once during their life. However, 30.4% of the children’s mothers have mentioned that they had not visited any orthodontic clinic. Therefore, there is a need to develop awareness and knowledge among the parents of children suffering from Down syndrome.
... A recent systematic review reported 5.1 mm resolution of mandibular incisor crowding with passive lower lingual arch therapy [8]. However, conflicting notion exists in the literature with regards to the early management of mandibular incisor crowding and resultant long-term dental health benefits [9,10]. Further, clinical studies could not demonstrate long-term lower incisor positional stability through ALPS when compared to mixed dentition expansion protocols or extraction of premolars [11]. ...
Background
Arch length preservation strategies utilize leeway space or E-space in the mixed dentition to resolve mild to moderate mandibular incisor crowding. The purpose of this systematic review of the literature was to analyze the effects of arch length preservation strategies in on mandibular second permanent molar eruption.
Methods
A search for relevant articles published from inception until May 2020 was performed using PubMed/Medline, Cochrane databases, Clinicaltrials.gov, Google scholar and journal databases. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adopted for the conduct of the systematic review. Using RevMan 5.3 software, the most pertinent data were extracted and pooled for quantitative analysis with 95% confidence intervals. Heterogeneity was analyzed by using Cochran Q test and I squared statistics.
Results
A total of 5 studies involving 855 mixed dentition patients with arch length preservation therapy were included in the qualitative analysis. Pooled estimate of the data from two studies revealed 3.14 times higher odds of developing mandibular second molar eruption difficulty due to arch length preservation strategies using lingual holding arch (95% CI; OR 1.10–8.92). There was no heterogeneity found in the analysis. The certainty levels were graded as very low.
Conclusions
This systematic review demonstrates that arch length preservation strategies pose a risk for development of mandibular second molar eruption disturbances, but the evidence was of very low quality.
Registration number : CRD42019116643.
... Most patients with malocclusion seek treatment to improve aesthetics, psychosocial relationships, and quality of life (QOL) [1]. However, orthodontic treatment could also improve oral functions [2] and oral health [3]. Demand for orthodontic treatment and treatment outcome satisfaction is not necessarily in correlation with the objective malocclusion records and the clinician's opinion [4]. ...
Introduction/Objective. This study aimed to translate the original disease specific Malocclusion Impact Questionnaire (MIQ) into Serbian and validate the new version in the cohort of young Serbian orthodontic patients. Methods. At the university clinic 154 patients filled out MIQ in Serbian before the start of the orthodontic treatment from which 112 participants completed the same questionnaire after four weeks. Index of Orthodontic Treatment Need (IOTN-DHC) and Peer Assessment Rating (PAR) pretreatment score were recorded. Descriptive statistic, Cronbach?s Alpha, Spearman's rho and Exploratory Factor Analysis followed by Parallel Analysis for factor reduction were calculated and analyzed. Results. One hundred forty-eight patients with no missing responses (51 male, 97 female), average age 13.3 ? 2.00 years had MIQ total scores mean of 10,14 ? 7,451. Internal reliability (? = 0.913), external reliability (? = 0.906; p = 0.000), construct validity tested by MIQ total scores and two global question scores correlations (? = 0.682; p = 0.000 and ? = 0.366; p = 0.000), as well as clinical validity tested by correlations of MIQ total scores with PAR pretreatment scores (? = 0.181; p
... These results mirror debates in the scholarly literature about the extent to which bite correction is esthetic as opposed to medically necessary. [33][34][35] The muddled boundaries are exemplified by a comment from a user who stopped DTC aligner treatment because she "was viewed more as a customer than a patient." ...
Background
The rise of direct-to-consumer (DTC) orthodontics has caused significant controversy among dentists and orthodontists. However, little is known about the actual harms or benefits experienced by users of at-home teeth aligners.
Methods
The authors designed a 24-item online survey to assess users’ experiences with at-home aligners. The authors recruited users for 6 months (March-August 2019) on social media platforms (Instagram, Twitter) and online forums related to DTC orthodontics. A total of 470 responses were analyzed.
Results
The typical respondent was a white, female millennial (23-38 years old in 2019) who purchased aligners to correct crowding. More than one-half of respondents consulted with a dentist before purchasing aligners. In those interactions, the dentist most often recommended an in-office treatment. Although most respondents (87.5%) were satisfied with DTC treatment, 6.6% had to visit their dentist due to the severity of adverse effects.
Conclusions
Although many respondents would have preferred traditional treatment from a dentist or orthodontist, they opted for DTC aligners because of cost and convenience.
Practical Implications
Rather than warning patients wholesale against at-home aligners, it might be more productive for dentists to have frank discussions with them about the risks and benefits. In parallel to pushing for increased accountability, it might be prudent to consider new ways of coexisting in this altered landscape, such as offering professional oversight of DTC treatments.
... Psychological effects of different malocclusions have long been of interest in orthodontics since dentofacial problems might have possible effects on psychological well-being [1][2][3][4]. It has been emphasized that dentofacial characteristic may have a high potential to affect self-esteem, especially when there is a strong social and sentimental interaction [5]. Besides, it has been indicated that children and adolescents' facial attractiveness has been found to be associated with social acceptance [6,7]. ...
Objective
The aim was to compare Rosenberg self-esteem scale (RSES), sensitivity to criticism scale (STCS) and social appearance anxiety scale (SAAS) scores of individuals with different types of malocclusions, and investigate the correlation between these scores and the index of complexity, outcome and need (ICON) score.
Materials and methods
One hundred and twenty individuals, who did not have any previous orthodontic treatment, were included. Group 1 included 40 patients with Class I malocclusion (median age of 14 years), Group 2 included 40 patients with Class II malocclusion (median age of 14.25 years) and Group 3 included 40 patients with Class III malocclusion (median age of 15.15 years). ICON scores were 46, 53 and 56 for Groups 1, 2 and 3, respectively. RSES, STCS and SAAS questionnaires were performed to the patients. Student’s t-test, one-way analysis of variance (ANOVA), Mann–Whitney’s U and Kruskal–Wallis’s tests were used for the statistical analysis.
Results
Group 1 showed significantly higher level of RSES scores compared to Groups 2 and 3 (p<.05). STCS scores were found to be significantly higher in Group 2, compared to other groups (p<.05). Group 1 (32.53 ± 8.94) showed significantly lower level of SAAS scores compared to Group 2 (39.63 ± 9.28) and Group 3 (39.42 ± 10.54) (p<.05). A significant positive correlation was found between the ICON and SAAS scores (r = 0.247, p=.007).
Conclusions
Adolescents with Class II and III malocclusions reported higher levels of social appearance anxiety scores, and lower levels of self-esteem scores compared to Class I. Complexity of orthodontic treatment need showed a significant impact on social appearance anxiety.
... Adolescence is a stage of life that offers the potential to prevent both current impairment and future illness and promoting successful development into productive adulthood. [13] In the current study among 12-15 years, the mean age (13.4 ± 1.1 years) is in line with earlier studies. [5,[14][15][16][17][18] Majority were females in the present study (53.3%) which is in accordance with four studies, [4,[14][15]17] whereas, three studies reported majority of males. ...
Objectives
The objective of the study was to assess the association of self-esteem (SE) with perceived orthodontic treatment need and oral health-related quality of life (OHRQoL) among 12–15 years old schoolchildren in Bengaluru city, India.
Materials and Methods
A cross-sectional study was conducted among 400 schoolchildren aged 12–15 years in Bengaluru city, India. The data were collected on a structured pro forma that included demographic profile, perceived orthodontic treatment need questionnaire, Child Oral Health Impact Profile (COHIP), and the modified version of the Harter’s self-perception profile rated by the children. ANOVA, Chi-square test, and multivariate linear analysis models were used. P < 0.05 was considered as statistically significant.
Results
The mean age of the study group was 13.21 ± 1.08 years. Most of the study participants were female (53%). Among the participants, 67% perceived orthodontic treatment need. Mean scores for COHIP and SE were 38.3 ± 10.7 and 91.5 ± 8.3, respectively. In multivariate linear regression analysis, SE was significantly associated with OHRQoL (0.161 [95% confidence interval CI 0.086–0.235)] and perceived orthodontic need [−0.701 (95% CI −1.252, −0.151)].
Conclusion
In this study, orthodontic treatment needs influenced SE and OHRQoL in the children. Hence, early diagnosis and prompt treatment can improve SE and OHRQoL.
... It is important for health professionals to provide accurate and evidence-based information about both the risks and the benefits of treatment (18,19). In light of the findings in this study, it would seem reasonable to consider discussing the improved focus on oral hygiene, diet, and general dental health awareness with patients/parents as potential benefits of orthodontic treatment. ...
Background and objectives:
Recent years have seen increased research investigating treatment outcomes from a patient perspective. However, parental perceptions are also important, as parents provide useful feedback. There is general acceptance that patients, and their parents, seek treatment for reasons including improvements in aesthetics, function, and quality of life. However, there is still little high-quality evidence regarding how these are affected by treatment. This qualitative study explored parental perceptions of treatment outcomes.
Subjects and methods:
One-to-one, semi-structured, in-depth interviews were undertaken with parents of adolescent patients who had completed a course of fixed appliance treatment to ascertain how they felt about the outcomes of their child's treatment. Interviews were digitally recorded, transcribed verbatim, and analysed using thematic analysis, through a framework method approach. A number of the parents interviewed were 'paired' with the patients included in Part 1 titled "Perceptions of outcomes of orthodontic treatment in adolescent patients: a qualitative study", thus allowing paired data to be considered. Because of the qualitative nature of this study, no statistical testing was undertaken.
Results:
Twenty-two parents were interviewed. Thematic analysis identified three main themes, and associated subthemes, relating to outcomes of treatment: health-related behavioural change, dental health, and psychosocial influences. The majority of parents discussed health-related behavioural changes, suggesting potential long-term benefits of treatment.
Limitations:
Although the study involved a typical cohort of parents for the hospital where the study was undertaken, the results may not be generalizable to all orthodontic parents/patients.
Conclusions and implications:
Parents reported three key themes related to benefits of their child's orthodontic treatment and these provide valuable evidence for orthodontic treatment benefits.
... Nevertheless, these claims are not supported by evidence. [1] The World Health Organization (WHO) stated that orthodontic treatment's main benefit is the improved self-esteem of the patients and their greater quality of life. Nonetheless, many authors have ascertained the functional benefits of orthodontic treatment in terms of improving mastication in cases such as anterior open bite and enhancing the acceptability of better oral hygiene. ...
... Facial appearance especially dental esthetics had a strong impact on the psychological and social adjustments. [11,12] Expectation and opinion of the patient toward dental esthetics cannot be underestimated, as it is they who benefit from improved esthetics after orthodontic treatment. [13,14] Professional opinion and patient opinion of facial appearance, dental esthetics, and malocclusion may not be coincident, and often orthodontic treatment is influenced by the perception of the patient regarding their appearance. ...
... 4,5,6 It was initially claimed that facial features, especially those related to oral aesthetics, may have a high potential to influence self-esteem, especially during life stages when there is intense social and affective interaction. 7 However, the scarce literature on the subject provides conflicting evidence, with some authors arguing that malocclusion affects patients' self-esteem; 8,9 while others report weak to nonsignificant effects of malocclusion 10 or orthodontic treatment. 11,12,13 Reasons are probably related to the multifactorial nature of selfesteem and how individuals may weight individual factors differently. ...
Objective::
To compare self-esteem scores in 12 to 16-year-old adolescents with different Angle malocclusion types in a Peruvian sample.
Material and methods::
A cross-sectional study was conducted in a sample of 276 adolescents (159, 52 and 65 with Angle Class I, II and III malocclusions, respectively) from Trujillo, Peru. Participants were asked to complete the Rosenberg Self-Esteem Scale (RSES) and were also clinically examined, so as to have Angle malocclusion classification determined. Analysis of covariance (ANCOVA) was used to compare RSES scores among adolescents with Class I, II and III malocclusions, with participants' demographic factors being controlled.
Results::
Mean RSES scores for adolescents with Class I, II and III malocclusions were 20.47 ± 3.96, 21.96 ± 3.27 and 21.26 ± 4.81, respectively. The ANCOVA test showed that adolescents with Class II malocclusion had a significantly higher RSES score than those with Class I malocclusion, but there were no differences between other malocclusion groups. Supplemental analysis suggested that only those with Class II, Division 2 malocclusion might have greater self-esteem when compared to adolescents with Class I malocclusion.
Conclusion::
This study shows that, in general, self-esteem did not vary according to adolescents' malocclusion in the sample studied. Surprisingly, only adolescents with Class II malocclusion, particularly Class II, Division 2, reported better self-esteem than those with Class I malocclusion. A more detailed analysis assessing the impact of anterior occlusal features should be conducted.
... The main reasons for orthodontic treatment are usually an improvement in facial or dental aesthetic (2). The benefits of orthodontic treatment is hard to justify if treatment is based on improvement in oral or dental health for the majority of orthodontic patients (4). Previously published study indicate an encouraging awareness of the psychosocial benefits of orthodontic treatment (5). ...
Aim:
The aim of our study is to compare incidence of orthodontic malocclusion based on occlusal indices and Index of Orthodontic Treatment Need (IOTN), and to evaluate the most commonly used method among the dentists for orthodontic treatment in Sarajevo.
Material and methods:
The sample consisted of 110 (31 female and 79 male)subjects older than 16 years with complete permanent dentition. Subjects were examined according to Occlusal Index (Angle classification of malocclusion, overjet, overbite, dental arch crowding and tooth rotation) and IOTN index. We conduct survey regarding which indexes are used in deciding on orthodontic treatment need, among primary health care and Orthodontist.
Results:
The present study show differences between the presence of malocclusion and treatment need as assessed by these two used indices. Based on the survey that we conduct all primary health care doctors use Occlusal Index to decide need for orthodontic treatment, more than 95% of orthodontic specialist use Occlusal Index for treatment need estimation.
Conclusion:
When measuring and grading treatment needs we should rely on Index of orthodontic treatment need. In such high demand for orthodontic treatment need it is necessary to establish need for the orthodontic treatment as fundamental, so that individuals with greatest treatment need can be assigned priority.
... [5] Malocclusion is a chronic condition and therefore, treatment of malocclusion has been associated with a great degree of subjectivity and varied perceptions of treatment need. [3] Despite the inconsistent evidence regarding the affect of malocclusion on long-term psychosocial well-being, it has been observed that the facial features, including oral esthetics have a potential to influence self-perceived appearance, [6] especially during that phase of life involving intense social and affective interaction. For older adolescents and younger adults, physical attractiveness plays an important factor affecting social relationships and self-perception which in turn can affect the quality of life. ...
Introduction: Malocclusion is a developmental condition signifying a mal-relationship between the arches. It is classified into several types and manifest variably from person to person. Aim: To evaluate the severity of the malocclusion and orthodontic treatment needs in 16–24-year-old Indian young adults. Materials and Methods: A cross-sectional study was conducted among 660 subjects (352 males; 308 females) residing in rural areas of Dehradun, India. Clinical examinations were conducted using the dental esthetic index (DAI) to evaluate the extent of orthodontic treatment needs among the population. Results: The mean DAI score of the sample was found to be 31.08 ± 7.98. No gender-wise differences were found. Statistically significant differences were observed between the age groups. Diastema between males and females was the only component where differences were found to be statistically significant. Conclusion: Around 45.15% of the total sample had a highly desirable and mandatory orthodontic treatment need. Gender did not influence treatment need whereas age group was found to influence it.
... JPH -Year 6, Volume 5, Number 3, 2008 the possibility to reduce risk of periodontal or carious diseases and incidence of dental injuries caused by increased overjet, but there is not evidence to support this [32,33]. Among the risks there is the possibility of damage during the therapy, increased predisposition to dental diseases during the treatment, failure of the therapy and relapse. ...
p> Background : Orthodontic Treatment Need Indexes are investigated to evaluate their validity criteria and their formulation on a scientific basis.
Methods : A bibliographic research was performed on Medline Database to find articles about orthodontic treatment need indexes published from 1960 to 2007. English language papers about criteria to establish indexes, their validity and reproducibility, and comparing two or more indexes were chosen.
Results : The study shows that orthodontic treatment need indexes are not based on evidence but are all based on the opinion of experts, although widely shared by the orthodontic community since the use of these indexes in clinical practice. The validity is assessed in terms of objectivity of the measurements needed to evaluate the clinical severity of the case under consideration. In this case, the quantitative methods seem to be more reliable and objective than the qualitative.
Conclusions : Currently in the orthodontic field the theory that orthodontic therapy is useful to prevent any disease in the patients is not supported by evidence based medicine. The recommendations about orthodontic treatment need should come from scientific debates, in order to support consensus based decisions.</p
... Studies have not reliably confirmed the presence of positive effects of orthodontic treatment on periodontal health or the reduction in the incidence of dental caries (Bollen et al., 2008;Helm and Petersen, 1989). Also, comprehensive reviews concluded that, based on currently available evidence, orthodontists should avoid claiming that orthodontic treatment has the potential to influence TMD (Burden, 2007). Psychologically, orthodontic treatment can enhance some aspects of oral health-related quality of life, however, self-esteem does not appear to be significantly affected (Kiyak, 2008). ...
This study aims to assess the orthodontic diagnostic skills, referral patterns, and the perceptions of orthodontic benefits of pediatric and general dentists in comparison with orthodontists.
Two online surveys were e-mailed to pediatric dentists, general dentistry practitioners, and orthodontists registered as members of the Saudi Dental Society and the Saudi Orthodontic Society. The surveys included questions about the type of orthodontic treatment provided, referral trends, and timing; presumed benefits associated with successful orthodontic treatment; and diagnosis and treatment plans of seven cases representing different malocclusions.
In total, 25 orthodontists, 18 pediatric dentists, and 14 general practitioners completed the survey. Only 38.8% of pediatric dentists and 7.1% of general practitioners reported that they practiced orthodontics clinically. The perceptions of the three groups toward the benefits of orthodontic treatment were comparable in the psychosocial areas. However, the orthodontists perceived significantly lesser effects of orthodontic treatment on the amelioration of temporomandibular disorder (TMD) symptoms. Pediatric dentists tended to rate the need and urgency of treatment higher, while general practitioners tended to rate the need of treatment lower. The selected treatment plans for three early malocclusion cases showed the greatest discrepancies between the orthodontists and the other two groups.
The orthodontists consistently and significantly downplayed the perceived benefit of orthodontic treatment to reduce TMD symptoms. Also, while there was a similarity in the diagnosis, there were notable differences in the proposed treatment approaches, perceived treatment need, and timing of intervention between the three groups of practitioners.
... Yet clinical studies fail to consistently demonstrate a causal relationship. A 2007 review by Burden 20 entitled "Oral Health-Related Benefits of Orthodontic Treatment" in this same publication concluded that "orthodontists today could not claim to prevent caries by orthodontic intervention" and that "orthodontic treatment confers neither harm nor benefit in terms of long-term periodontal health." A more recent systematic review of the literature by Hafez et al. ...
... Despite the lack of consistent evidence, that malocclusion can affect psychosocial wellbeing in the long term[1]it has been claimed the facial features, especially oral aesthetics had a potential to influence self-perceived appearance[2]especially during the phase of life when there is intense social and affective interaction. For young people physical attractiveness is an important factor affecting social relationships[3]. ...
Background
Aesthetic alterations in the face can be self-perceived and can affect quality of life. For young people, physical attractiveness is an important factor affecting social relationships. The aim of this study was to estimate the prevalence of malocclusion, identify the most common types and test its association with oral aesthetic self-perception in 18 to 21 year-old population of male young adults.
Methods
A cross-sectional study was carried out involving 138 Brazilian Army soldiers. Data collection included socio demographic profile, malocclusion status through the Dental Aesthetic Index (DAI) and oral aesthetic self-perception as indicated by the Oral Aesthetic Subjective Impact Scale (OASIS). The chi-square and Fisher’s exact test were used to test for homogeneity of proportions. The stepwise multivariate logistic regression analysis was used to test for the relationship between the poorer oral aesthetic self-perception and parental and soldier’s education, per capita income, history of caries in all teeth and only on anterior teeth, dental trauma, previous orthodontic treatment and malocclusion.
Results
The prevalence of malocclusion was 45.6%. Incisor teeth crowding and misalignment of lower incisors were the most common types of malocclusions. A statistically significant and independent association between malocclusion and poorer oral aesthetic self-perception in the multivariate analysis was observed. Subjects with severe malocclusion conditions showed 88% higher prevalence [prevalence ratio =1.88 (95% CI, 1.30 – 2.72); p = 0.001] of poorer aesthetic self-perception comparing to those with minor malocclusion.
Conclusions
A high prevalence of malocclusion was observed. The young adults presenting severe malocclusion had a higher and independent prevalence of poorer oral aesthetic self-perception.
AIM: The primary aim of the thesis is to investigate factors impacting on the child, adolescent, or parent in their decision to seek orthodontic care. The study has three objectives: 1) To investigate clinical and non-clinical factors influencing pre-treatment perceived need for orthodontic care by both parent and child/adolescent 2) To determine the amount a parent is willing to pay (WTP) pre and post treatment in order to obtain the benefit of straight teeth for their child, and 3) To investigate factors that influence patient compliance (in terms of hygiene) during fixed appliance treatment. The investigation is important in the current economic environment as orthodontic services tend to be an extremely expensive intervention and can be publicly funded. The research is influenced by studies highlighting that perceptions of need for care are multi-factorial and often influenced by non-clinical elements. Recent studies have highlighted the necessity for essential behavioural propensity assessment. RATIONALE: As orthodontic services are an expensive healthcare intervention, it is important to continue to examine the factors that may affect demand and outcomes in publicly funded and privately funded healthcare systems. There are very few studies on WTP in mainstream orthodontics. METHOD: It is a prospective longitudinal study using convenience sampling. The sample was stratified by age and gender, and consists of 177 subjects from the Republic of Ireland (RoI) and 177 from Northern Ireland (NI). The treatment modality was fixed appliance orthodontic treatment. The patients, aged 12 to 18 years (mean = 13.5), were studied in three different healthcare funding systems, from recruitment in 2004 until the completion of follow-up questionnaires in 2008. Instruments used to collect data included a patient administered interview at both pre- and post-treatment, two parent self-administered instruments, and a compliance instrument administered by the orthodontist. The pre- and post-treatment models were scored using Peer Assessment Rating (PAR), and the Index of Orthodontic Need (IOTN). The Dental Health Component (DHC) and the Aesthetic Component (AC) were scored by orthodontists. The orthodontists administering the treatment judged compliance and questionnaires were completed three months from the start of treatment and at the time the braces were removed. The data was analysed descriptively and empirically. The empirical analysis was undertaken using bivariate and multivariate regression analysis. RESULTS: The results indicate a misalignment between professionally assessed IOTNAC, and the child’s perceived need. Perceived need for orthodontic treatments was more pronounced in children treated in privately funded healthcare systems and was influenced by peer groups in both public and private funding systems. Parental factors influencing perceived need were the appearance of their children’s teeth and gender differences. Parents from both NI and RoI had high perception of need levels with no significant difference between parents who are publicly funded or those who pay fees privately. Willingness to pay at the pre-treatment was associated with higher parental income and WTP did not change pre- and post-treatment. Parents from the RoI were willing to pay more than their NI counterparts, and this was true, whether or not, they were paying full societal or subsidized fees. Parental WTP pre-treatment and at completion is closely related to the societal market values for the jurisdiction and was related to ability to pay in both funding systems. There was no difference in the level oral hygiene compliance by those treated in either funding system. Compliance during treatment was better in females and children/adolescents from higher income households. More highly compliant children/adolescents had better treatment outcomes and lower PAR scores. CONCLUSIONS: The misalignment between perceived need and normative need may be due to lack of education in terms of what is a socially acceptable level of dento-facial appearance. The expectations of publicly funded patients/parents and their misalignment between perceived need and the value they place on treatment may not always be grounded, in practical realities but rather in external influences. Means testing would help public systems identify those who cannot afford treatment, but have a definite need for treatment. Practitioners and policy makers should consider whether the criteria for qualification for orthodontic treatment in healthcare systems should include an assessment of oral hygiene levels and cooperation. This thesis contributes by highlighting the importance of patient and parental perception and societal expectations on the demand for orthodontic care. In terms of behavioural propensity, the study provides an insight into the qualification for treatment based on potential behavior during treatment. The study has developed a practical tool for use by practitioners to gain an insight into the possible compliance of a child, depending on what is motivating them to seek treatment.
Orthodontic treatment is often provided on the assumption that improvements of oral function and aesthetics will result in improved self-esteem (SE) and oral health-related quality of life (OHRQoL). This article reviews the current available literature pertaining to the effect of orthodontic treatment on SE and OHRQoL, with a special focus on the longevity of any influence observed. Currently, there is no strong evidence to support that orthodontic treatment causes significant increases in SE and OHRQoL. Reports of treatment benefit in this regard remain equivocal, and the longevity of any effects on SE or OHRQoL remains unknown. This provides an insight into evidence-based treatment benefits and aids informed decision-making.
CPD/Clinical Relevance: An awareness of the effect of orthodontic treatment on self-esteem and oral health-related quality of life is important to allow a greater understanding of treatment benefit and satisfaction
Objective: To evaluate the duration of combined orthodontic and orthognathic surgical cases treated either in the public or private health system in Western Australia.
Methods: The clinical records of 100 patients from the Orthodontics Department from the University of Western Australia Dental School and 100 patients from a private orthodontic practice in Perth, Australia who received combined surgical-orthodontic treatment were retrospectively assessed. Three statistical models were applied to explore the associations between treatment time (total, pre-surgery and post-surgery), clinical setting and extractions.
Results: Total treatment time was shorter in the private setting: 18.8 months for non-extraction and 22.0 months for extraction cases, and longer in the public university setting: 24.5 months for non-extraction and 27.7 months for extraction cases. Pre-surgical treatment time was shorter in the private setting: 13.1 months for non-extraction and 17.1 months for extraction cases, and longer in the public university setting: 17.1 months for non-extraction and 21.1 months for extraction cases. Post-surgical treatment time was shorter in the private setting: 5.5 months and longer in the public university setting: 7.1 months.
Conclusion: In a Western Australian health system, the treatment duration of combined orthodontic and orthognathic surgery cases is longer in the public university setting than in private practice.
Objectives
The purpose of the study was to epidemiologically assess the prevalence of malocclusion and orthodontic treatment need in school-aged adolescents in Dubai using the Index of Complexity, Outcome, and Need (ICON). Null hypothesis tested was no significant differences in ICON scores among Dubai students as a function of gender or geographic/ethnic background.
Materials and Methods
The sample was 17,763 adolescents with nearly equal by gender; India and the United Arab Emirates were represented about the same. Scores for malocclusion from Peer Assessment Rating (PAR) index evaluations combined with the esthetic component of the Index of Orthodontic Treatment Need (IOTN) comprised the ICON score.
Results
Male ICON scores were significantly greater than female scores. Three scores contributing to ICON were significantly higher in males, i.e., buccal anterior-posterior occlusion, incisor overbite, and esthetic component. ICON scores for South Asia were significantly higher than the Middle East, i.e., 59.9 versus 52.4, P = 0.000. ICON scores were no different for the UAE males and females but otherwise significantly different (>) as follows: Indian males > Indian females > UAE males = UAE females.
Conclusions
Dubai school-aged adolescents treatment need is the same for the UAE males and females, but there is a significantly greater orthodontic treatment need for males and females from India.
Introduction:
Self esteem is more of a psychological concept therefore, even the common dental disorders like dental trauma, tooth loss and untreated carious lesions may affect the self esteem thus influencing the quality of life.
Aim:
This study aims to assess the impact of dental disorders among the adolescents on their self esteem level.
Materials and methods:
The present cross-sectional study was conducted among 10 to 17 years adolescents. In order to obtain a representative sample, multistage sampling technique was used and sample was selected based on Probability Proportional to Enrolment size (PPE). Oral health assessment was carried out using WHO type III examination and self esteem was estimated using the Rosenberg Self Esteem Scale score (RSES). The descriptive and inferential analysis of the data was done by using IBM SPSS software. Logistic and linear regression analysis was executed to test the individual association of different independent clinical variables with self esteem.
Results:
Total sample of 1140 adolescents with mean age of 14.95 ±2.08 and RSES of 27.09 ±3.12 were considered. Stepwise multiple linear regression analysis was applied and best predictors in relation to RSES in the descending order were Dental Health Component (DHC), Aesthetic Component (AC), dental decay {(aesthetic zone), (masticatory zone)}, tooth loss {(aesthetic zone), (masticatory zone)} and anterior fracture of tooth.
Conclusion:
It was found that various dental disorders like malocclusion, anterior traumatic tooth, tooth loss and untreated decay causes a profound impact on aesthetics and psychosocial behaviour of adolescents, thus affecting their self esteem.
Introduction:
Plaster casts as the medium for data collection in orthodontic studies pose disadvantages. In this study, we aimed to assess the validity and reliability of using 3-dimensional (3D) photographs instead of plaster casts to determine the Index of Orthodontic Treatment Need (IOTN) score.
Methods:
Data were collected retrospectively from the clinical records of 91 subjects. The IOTN grades were independently determined first from plaster casts, then from 2-dimensional (2D) and 3D photographs only, and then from 2D and 3D photographs combined with radiographs. IOTN grade agreement was assessed using kappa statistics and percentages of agreement.
Results:
The percentages of agreement between both photographic sets and the plaster casts varied among the different occlusal traits from 63.7% to 93.4%. Agreement between the IOTN grades obtained from 2D and 3D photographs only and the IOTN grades obtained from plaster casts was fair (K = 0.35). The reliability of using 2D and 3D photographs instead of plaster casts was improved when those were combined with radiographs.
Conclusions:
In general terms, orthodontic treatment need can be assessed from 2D and 3D pictures; however, the individual occlusal traits are sufficiently assessed only when these pictures are combined with radiographs. Plaster casts remain the preferred method compared with 3D pictures for assessment of the IOTN.
Objectives:
A detailed assessment of intentional incisor ablation among the Late Upper Paleolithic people of Tam Hang (northern Laos) was undertaken to understand how this cultural practice, in addition to age and sex, influenced an individual's inclusion in the mortuary context. The covariation of ablation status with occlusal variation and anterior dental pathology was addressed to study the implications of this cultural practice on oral health.
Materials and methods:
Sex, age, caries, antemortem tooth loss, and occlusal variation were assessed through standard osteological methods for 12 individuals. An observational protocol to identify intentional ablation was developed specifically for this sample.
Results:
Four ablation states were identified that range from no ablation to the removal of two, three, or four lateral (I2) incisors. The timing of ablation was attributed to ritual extractions during early adolescence. Adult age-at-death was the strongest indicator of inclusion in the main burial context and a child burial was isolated from those of adults. Ablation status does not strongly influence inclusion in the mortuary context. Individuals lacking ablation tended to have a higher incidence of anterior caries, pathological tooth loss, incisor crowding, and canine rotation.
Conclusions:
This study identifies the oldest case of intentional incisor ablation in Late Pleistocene Mainland Southeast Asia. We conclude that ablation does not always "compromise" the dentition; instead, it may have unintentional oral health benefits in some contexts. Am J Phys Anthropol, 2016. © 2016 Wiley Periodicals, Inc.
Malocclusions like deep bite, which destroys the palatal gingiva of the maxillary incisors, or an anterior crossbite with occlusal trauma might be harmful to the periodontium. Orthodontic treatment for patients with such malocclusions is often considered advantageous for periodontal health. Many patients undergoing orthodontic treatment develop a generalized form of gingivitis within a short period of time after insertion of the orthodontic appliance. At present, many bracket systems are in clinical use, with different designs and material characteristics. Several studies investigated the influence of different bracket types and archwire ligation techniques on plaque adhesion. More long-term high-quality investigations are necessary to elucidate whether changes in clinical periodontal parameters and oral and periodontal microbiology associated with the placement of orthodontic appliances, return completely to pretreatment levels after debonding.
Controversies in science are disagreements among researchers and/or clinicians about the validity of a theory/hypothesis, or a new or prevalent concept. This chapter presents some updated information on controversial topics in biological research into orthodontic tooth movement, and tries to find some evidence-based answers. Proper mechanotransduction events are essential for a cellular response, which is genetic expression and protein synthesis. The role of chemokines is mainly to promote chemotaxis, differentiation, and activation of osteoclasts favoring bone resorption. The current research trend revolves around administration of macrophage colony stimulating factor (M-CSF), an early osteoclast recruitment/differentiation factor, to accelerate tooth movement. It may, therefore, be concluded that well aimed and adequately funded research should amplify the knowledge needed for the elimination of persisting controversies that feed upon misinformation, wishful thinking, and ignorance.
Background and Etiology Prevalence Evidence on the Relationship Between Malocclusion and Periodontal Health Evidence on the Relationship Between Orthodontic Treatment and Periodontal Health Future Directions Acknowledgments
Class II division 1 malocclusion is common and various methods have been suggested for successful treatment in the growing patient. A number of recent high-quality studies have been undertaken to assess the efficacy of these treatments. We aim to outline the existing best evidence that supports current practice, with a review of the effect of treatment timing on outcome. This will provide a sound evidence-base for General Dental Practitioners for assessing, advising and referring young patients for treatment.
CPD/Clinical Relevance: General Dental Practitioners should understand the management options and optimal time for treating growing patients with a Class II division 1 malocclusion.
The commissioning of future dental services is once again in the spotlight as we move into the transition phase before the full effect of the commissioning boards comes in April 2013. The delivery of specialist orthodontic care has been particularly badly disrupted over the past 18
months with gross variations in the way in which procurement exercises have been undertaken by some primary care trusts. As a consequence, the British Orthodontic Society (BOS) has received complaints from both patients and specialists focusing on the disruption to the delivery of services
and continuity of patient care.
Het eerste deel van dit artikel is een bewerkte samenvatting van een artikel dat Donald J. Burden schreef in het themanummer 'Orthodontics: quality of care, quality of life' in Seminars in orthodontics (juni 2007). De auteur van het oorspronkelijke artikel verrichtte een systematisch literatuuronderzoek naar enige, historisch geclaimde, heilzame effecten van een orthodontische behandeling, zoals een verminderde kans op cariës, parodontale aandoeningen, trauma van de tanden en op temporomandibulaire stoornissen. Op basis van de door hem verzamelde literatuur acht hij de heilzame werking op deze terreinen echter onbewezen. Het tweede deel van dit artikel behelst een kritisch en genuanceerd commentaar op de inhoud van het artikel en de conclusie van Burden.
The aim of this case report was to describe the orthodontic and periodontal management of a patient with three impacted anterior teeth.
An 18-year-old female with Class I crowding on a Class I skeletal base presented with the chief complaint of an unaesthetic smile. Clinical examination revealed an impacted upper right permanent canine (13), lateral (12) and central incisor (11), a retained deciduous incisor and moderate crowding in the lower arch. The impacted teeth were surgically exposed (closed exposure) and aligned with fixed appliances. The 12 was extracted due to root resorption and 44 extracted to resolve the lower arch crowding. A fraenectomy and gingival recontouring were required.
Orthodontic treatment resulted in improved overjet, overbite and an acceptable facial profile. The patient reported improved self esteem.
While impacted anterior teeth are a clinical challenge, their surgical exposure, in combination with fixed appliances, is a conservative treatment plan which is not without complications.
It has been demonstrated that fluoride prophylactic agents may cause hydrogen absorption in NiTi wires and degrade their mechanical properties.
To investigate the effect of a fluoride mouthwash on load-deflection characteristics of three types of nickel-titanium-based orthodontic archwires.
Twenty maxillary 0.016 inch round specimens from each of the single-strand NiTi (Rematitan 'Lite'), multi-strand NiTi (SPEED Supercable) and Copper NiTi (Damon Copper NiTi) wires were selected. The specimens were kept in either 0.2% NaF or artificial saliva solutions at 37 degrees C for 24 hours (N = 10). The wire load-deflection properties were measured by a Zwick testing machine, using a three-point bending test. An un-paired student's t-test, a one-way ANOVA and a Tukey post-hoc test were used to assess statistical significance.
Immersion in NaF solution affected the load-deflection properties of NiTi wires. The unloading forces at 0.5 and 1.0 mm deflections were significantly lower in fluoride-treated specimens compared with the control groups (p < 0.05). Unloading forces at 1.5, 2.0 and 2.5 mm deflections were not statistically different between fluoride- and saliva-treated specimens (p > 0.05).
The results suggested that subjecting NiTi wires to fluoride agents decreased associated unloading forces, especially at lower deflections, and may result in delayed tooth alignment.
To examine the effects of face mask therapy with and without associated rapid maxillary expansion (RME) in adolescent patients presenting with skeletal Class III malocclusion characterised by maxillary retrognathism.
Case records consisting of lateral cephalograms and hand-wrist films of 43 patients with hypoplastic maxillary Class III malocclusions treated using a face mask with and without an RME were analysed. The patients were divided into two groups; Group A (N = 27) were treated with a face mask coupled with rapid maxillary expansion and patients in Group B (N = 16) were treated with a face mask appliance only. Ten cephalometric linear and 9 angular variables were measured to assess the dentofacial changes. Within group and between groups comparisons were determined by a paired t-test and Student's t-test, respectively.
Forward displacement of the maxilla and a clockwise rotation of the mandible occurred in both groups. The maxillary-mandibular relationship improved and soft-tissue changes resulted in a more convex profile. The maxillary incisors moved forward only in Group B subjects but the mandibular incisors moved backward in both groups.
Face mask therapy with and without an associated RME improved skeletal Class III malocclusion by a combination of skeletal and dental changes. These results suggested that the use of an RME should be based on clinical criteria rather than assisting the Class III correction.
To compare palatal height index, arch width, and arch length characteristics in Iranian patients presenting with palatal and buccal canine impaction with a matched control group.
The casecontrol study examined 53 patients with canine impaction. The subjects were divided into two groups determined by buccal or palatal impaction which were compared with 53 control subjects presenting without impaction. Subjects in the experimental groups were matched with individuals in the control group according to age, gender, crowding and type of malocclusion. Palatal height and arch length were measured with a Korkhaus three-dimensional divider. Arch width was determined in the anterior and posterior portions of the maxillary arch with a digital caliper. Data were compared with paired t-tests.
The buccal canine impaction group exhibited mean differences in arch length between the case and control groups of 0.8 mm (SD 1.63, p = 0.041). The differences between the case and control groups in intermolar width, interpremolar width, intercanine width, palatal depth, and palatal height index were not statistically significant. The palatal impaction group showed no statistically significant differences between the case and control group in any of the dependent variables (p < or = 0.05). In a retest examination of arch dimensions, Bland-Altman plots showed no differences between the first and second measurements.
Arch length in the buccal canine group was the only statistically significant variable. The difference was small and was considered not clinically significant.
To determine the possible risk factors for external apical resorption (EARR) of the maxillary incisors.
Panoramic radiographs of 132 orthodontic patients with a mean age of 16.9 +/- 3.6 years were selected from two practice centres in Tehran. The radiographs were taken between 1990 and 2005 and 63.6% of the subjects were female. Mean, standard deviation and distribution of EARR for various variables were assessed. Prevalence significance, as well as differences between frequency distributions of clinical EARR (> or = 1.2 mm) between genders, treatment plans (extraction/ non-extraction), initial overjet and overbite magnitude, and incisor types (centrals/laterals) were evaluated by the chi-squared test. The mean resorption rates on central and lateral incisors were compared using the independent-samples t-test. Associations between EARR with the age, duration of treatment, pretreatment overjet and overbite were assessed by the Pearson's correlation test. The reliability of the method was determined by remeasuring 117 randomly selected incisors and determining the associations between both sets of measurements with the Pearson's correlation coefficients.
The prevalence of EARR, and clinical EARR (> or = 1.2 mm) were 91.8% and 44.78% respectively. The average of EARR was 1.377 +/- 1.214 mm, or 8.65 +/- 8.021% of pretreatment root lengths. The prevalence of clinical EARR was significantly higher in extraction cases, cases with greater initial overjet and on lateral incisors. Using the t-test, significant differences (p < 0.05) were observed between the extent of resorption between genders (higher in females), treatment plans (higher in extraction cases) and incisor types (greater on lateral incisors). Longer treatment times and excessive initial overjet were correlated with higher EARR levels (p < 0.05, r < 0.2).
Factors related to premolar extraction, initial ovejet size, treatment time and being female may be correlated with higher EARR. Clinically significant resorption did not occur more in females.
To examine the influence of different crosshead speeds on the in vitro shear bond strength and adhesive remnant index scores for the same orthodontic adhesive.
One hundred human molars were randomly allocated to four groups. Brackets (.022 inch Victory series, 3M, Monrovia, CA, USA) were bonded with Ortho Solo primer (Ormco, Glendora, CA, USA) and Enlight (Ormco, Glendora, CA, USA) adhesive paste to their buccal surfaces. The brackets were debonded with a universal testing machine (Instron, Canton, MA, USA) with each group subjected to a different crosshead speed of 0.5 mm/min, 1.0 mm/min, 2.0 mm/min and 5.0 mm/minute. Shear bond strength (SBS) was measured and enamel surfaces were examined to determine the adhesive remnant index (ARI) score.
No significant differences were found between the mean SBS or ARI score for any of the groups.
Studies using different crosshead speeds when testing identical adhesives may be used to compare the SBS of other orthodontic adhesives, provided the testing protocols are similar.
The decision regarding extraction or non-extraction orthodontic treatment for patients with different skeletal facial patterns is more commonly based on traditional concepts rather than scientific facts. The present study aimed to investigate whether dolichofacial patients responded differently compared with mesofacial patients to non-extraction orthodontic treatment with respect to vertical changes in facial height.
Twenty-eight dolichofacial patients and 29 mesofacial patients who underwent non-extraction orthodontic treatment were selected. All patients commenced treatment prior to 15 years of age and had a mean age of 12.3 years for the dolichofacial group and 12.6 years for the mesofacial group. Serial lateral cephalometric radiographs were traced by hand on acetate paper and digitised using the Rocky Mountain Orthodontics JOE 32 programme. Statistical analysis examined the recorded changes in facial axis angle, facial angle, menton-to-ANS distance and facial convexity.
An increase in menton-to-ANS distance and facial angle and a decrease in facial convexity were observed in both groups to a similar extent. Interestingly, the facial axis of both groups remained constant throughout treatment and up to two years post-treatment. Both groups showed slightly increased facial axis angle beyond the original value at two years post-treatment. No statistically significant difference between the two groups was observed in the changes of any of the variables over time.
The results countered the traditional concept that dolichofacial patients would have an increased facial height after being subjected to non-extraction orthodontic mechanics. It appeared that long-term vertical height of the face was more dependent on genetics rather than environmental influences.
This study aimed to establish a safety zone for the placement of mini-implants in the buccal surface between the second maxillary premolar (PM2) and first maxillary molar (M1) of Mongoloids.
Thirty-two digital orthopantomograms of Mongoloids were selected and the interdental distance between the second premolar and first molar at 2, 5, 8 and 11 mm from the cemento-enamel junction (CEJ) was measured. The distance between the PM2 and M1 root apices and from the apices to the maxillary sinus was also determined.
The average width (mm) at 2 mm was 2.58 +/- 0.53; 5 mm was 3.47 +/- 0.61; 8 mm was 4.00 +/- 0.74, 11 mm was 4.36 +/- 0.71 and the distance between the apices was 7.49 +/- 0.79. Only half of the samples were measured at 11 mm, as many of the root apices were superimposed over the maxillary sinus. The measurement (mm) from PM2 root apex to the sinus was -0.18 +/- 1.56, from the mesiobuccal root apex of M1 (MB1) to the sinus was -1.94 +/- 1.70 and from the midpoint between their apices to the sinus was -2.96 +/- 2.06 (superimposed on the sinus).
The safest area to place mini-implants between the second premolar and the first molar in the maxilla of Mongoloids is between 5 to 8 mm above the CEJ.
The criteria that dentists use to judge the need for orthodontic treatment are not clear. This study investigates variation in dentists' perception of orthodontic treatment need. Seventy-four dentists were asked to assess 320 dental casts in relation to aesthetic and dental health need. The results of this investigation revealed that the panel was divided as what constituted a need for orthodontic treatment on dental health grounds. It is suggested that one method of achieving a more uniform evaluation of orthodontic treatment need is the use of an occlusal index. Until an occlusal index is accepted and used by the profession, the distortion of need and demand for orthodontic treatment by dentists' unequal perceptions will continue.
SUMMARY The aim of this study was to assess general dental practitioners’ and orthodontists’ perceptions of the benefits of orthodontic treatment. A specially designed questionnaire was sent to a random sample of 150 general dental practitioners (GDPs) and all orthodontists in Northern Ireland (excluding hospital practitioners) with a postgraduate qualification (n = 29). There was a 93 per cent response rate by the general dental practitioners and all but one specialist practitioner returned the questionnaire. The questionnaire comprised 14 visual analogue scales (VAS) whereby participants were asked to rate the importance of various possible dental health and psychosocial benefits of orthodontic treatment. In addition to the VAS, the influence of dentist variables such as number of years since qualification, orthodontic cases completed, referral rates and attendance at postgraduate lectures were examined. When ratings on the 14 dental health and psychosocial scales were examined overall, GDPs rated an improvement in self-esteem while orthodontists considered an improvement in physical attractiveness as the most important benefit of orthodontic treatment. Even though psychosocial variables received the highest ratings, examination of the mean ratings (and 95 per cent confidence intervals) revealed that some dental health factors were also rated highly by both groups. While the results do indicate an encouraging awareness of the psychosocial benefits of orthodontic treatment, they also suggest that both GDPs and orthodontists have an unrealistic expectation of the dental health gain likely to result from orthodontic treatment.
A questionnaire was sent to the parents of 261 7-8-year-old children, asking their views on their own child's dental appearance and function, their own dental appearance, history of orthodontic treatment in the family, and the best age for starting orthodontic treatment for children. Parents' opinions were compared with an orthodontist's assessment of treatment need. Parents' anxiety about their child's dentition coincided in 60 per cent with the orthodontist's assessment, agreement being stronger for malocclusions affecting the anterior teeth. The parents regarded the child's dental appearance and function to be good or rather good in 59 and 53 per cent, respectively, with only a few (7 and 9 per cent) regarding it as poor or rather poor. There was a statistically significant association between parents' anxiety and their opinion on the child's dental appearance and function, but no association was found between their anxiety and opinions on their own dental appearance. Most parents thought 7-8 years to be the best age for starting orthodontic treatment.The study indicates that in a dental care system, where children visit their dentist regularly, the parents' awareness of orthodontic problems agrees fairly well with the orthodontist's assessment of treatment need and the parents also seem to accept the concept of early treatment.
abstract – The occurrence and degree of displacement and rotation was recorded in the 4,316 fully erupted teeth of 154 Army recruits aged 19–22 years. Of the different teeth, it was the maxillary laterals and the mandibular second premolars which were most often found to be malaligned. In the maxillary anterior tooth areas, which had been fairly well brushed by the subjects, both the degree of oral cleanliness and the extent of periodontal disease were worse around the malaligned than around the aligned teeth. In the premolar areas the difference was less marked and it became non-existent in the molar regions. The results indicated that malalignment of the teeth, as such, does not enhance periodontal breakdown but that it decreases the effect of average oral hygiene measures. Exceptionally good oral hygiene measures or, on the other hand, no oral hygiene measures at all, are thus less likely to reveal an association between malalignment and periodontal disease.
Abstract The aim of the present investigation was to study (1) whether it was possible, by orthodontic tooth movement, to shift a supragingivally located plaque into a subgingival position, and (2) periodontal tissue reactions around tilted and intruded plaque-infected teeth.
The experiments were performed on five dogs which were fed a diet that allowed dental plaque accumulation. The lower third premolars (3P and P3) were extracted and a phase of experimental periodontal breakdown was initiated on day 0. The periodontal pockets around the lower fourth premolars (4P and P4) were eliminated on day 210. During surgery, a notch was prepared in the root at the level of the marginal alveolar bone in order to facilitate measurements in radiographs and histological sections. After 60 days of healing with plaque control, i.e. on day 270, orthodontic appliances producing tipping forces on 4p and P4 were inserted. From day 270 to day 450, plaque was allowed to accumulate on 4P (test = T) while P4 (control = C) was brushed twice daily. The dogs were sacrificed on day 450. Following sacrifice, tissue sections comprising 4P, 1M and P4, M1 were produced and subjected to microscopic analysis.
The present investigation showed that it was possible by orthodontic tooth movement to shift a supragingivally located plaque into a subgingival position. The mesial-apical movement of the plaque-infected teeth resulted in the formation of infrabony pockets. In four out of five dogs the displacement of the plaque-infected tooth resulted in an apical shift of the connective tissue attachment. When similar orthodontic forces were acting on plaque-free teeth, the tilting movement did not result in the formation of infrabony pockets. In only two dogs did the treatment result in loss of connective tissue attachment.
The relationships between traumatic injuries to upper incisors and incisal overjet were studied in a sample of 1445 orthodontically untreated children aged 7 to 16 years. Traumatic injuries of the hard dental tissues and exarticulations of teeth were recorded. The frequently of injuries was 14.2% in children with normal overjet (0--3 mm), 28.4% in children with increased overjet (3.1-6mm), and 38.6% in children with extreme overjet (greater than 6 mm). The severity of injuries was also greater in children with extreme overjet than in children with overjet ranging from 0 to 6 mm. Furthermore, the range of injuries increased in relation to the overjet. Two or more injured incisors were found in 19.2% of the children with normal overjet, in 22.2% of the children with increased overjet, and in 46.7% of those with extreme overjet.
Periodontal condition, plaque situation, and gingival status were studied longitudinally on five different occasions before, during, and after a full period of routine edgewise treatment in thirty-eight adolescents, 11 to 12 years old at the start. Extraction of permanent teeth was part of therapy in all cases. Thirty-nine matching persons who had not had any orthodontic treatment served as a reference group and were examined in an identical way. Loss of attachment was recorded with a periodontal probe on the mesial, distal, and facial surfaces of all permanent maxillary teeth except the second molars. A particular oral hygiene program was followed carefully by all orthodontic patients.The response of the preventive program was reflected in good or excellent oral hygiene and gingival condition throughout treatment. While no differences were registered during active therapy, after removal of the fixed appliances the orthodontic patients had significantly lower plaque scores and less gingivitis than the untreated persons.With regard to loss of attachment, there were no statistically significant differences between the two categories of patients at any of the five examinations. In fact, periodontal condition was excellent in both groups and the average loss of attachment was less than 0.1 mm. per surface.Although it was not possible with the methods used to demonstrate any statistically significant difference in periodontal condition between the treated and untreated adolescents shortly after band removal, the need for extended long-term studies is evident, as discussed. Such follow-ups are planned for both categories of patients in this study.
The relationship between traumatic injuries to upper permanent incisors and incisal overjet, with special reference to the age at which the trauma occurred, was studied in a sample of 1437 orthodontically untreated children aged 7--16 years. Traumatic injuries to hard dental tissues and exarticulations of teeth were recorded. Before 10 years of age, the increase of the prevalence rates was most rapid in the extreme (greater than 6 mm) overjet group in both sexes; the ratios between the extreme and normal (0--3 mm) overjet groups being 6.5/1 in girls and 5.0/1 in boys. According to the estimate, about 50% of the girls and 70% of the boys in this overjet group with injuries were affected before the age of 10 years.
A questionnaire survey of the expectations of orthodontic treatment was conducted among 200 orthodontic patients and parents in South Wales. The results were compared with those of a similar study in St Louis, Missouri. The central finding was the high expectations of the effects of treatment shared by both groups.
The prevalence of malocclusion, the need for and the demand for orthodontic treatment was studied in a randomly selected adult Swedish population > or = 20 years of age. Nine-hundred-and-twenty subjects were examined of whom 669 had their own teeth in occlusion. From those a group of 157 subjects was selected on the basis of objective need and/or subjective demand for orthodontic treatment. The various regimens of treatment required in this group were investigated. The prevalence of malocclusion ranged from 17 to 53 per cent in the various age groups. The spectrum of malocclusion was similar to that previously reported in Swedish children. The awareness of their malocclusion was higher among younger than older subjects and among those who had severe malocclusion. Objective treatment need, evaluated by two experienced orthodontists, was estimated at 11 per cent of the total population, whilst orthodontic treatment was requested by approximately 5 per cent of the population studied.
Two-hundred-and-forty-five consecutive prospective orthodontic patients and 245 controls matched for age, sex, and residence, but with minor need of orthodontic treatment, were examined.
The functional examination of the masticatory system was made according to Carlsson and Helkimo (1972), and Helkimo (1974). According to dysfunction index (Helkimo, 1974), 33.5 per cent of the patients and 21.6 per cent of the controls had a moderate, and 18.9 and 7.8 per cent respectively, a severe dysfunction. The corresponding figures for symptoms were 16.7 and 4.9 per cent respectively. In the patient group the frequency of signs and symptoms was higher in the older age group and in the girls.
Orthodontic patients appeared to be at greater risk of craniomandibular disorders (CMD) than individuals with minor need of treatment.
The prevalence of signs and symptoms attributed to craniomandibular disorders (CMD) was established in an orthodontically treated sample. The effect of orthodontic therapy upon this prevalence was studied by monitoring three groups of patients whose treatment procedures were different. The first group was treated with functional appliances, the second with Begg light wire, and the third with chin cups. In addition, the effect of extraction upon the prevalence was studied by monitoring three groups in which different extraction decisions had been made: four first premolars extracted, all other types of extraction, and no extraction. Based upon the finding of similar prevalences after 20 years of observation, it appears that neither orthodontic treatment nor extraction has a causal relationship with the signs and symptoms of CMD recorded during this study.
Seven-hundred-and-ninety-one 15-year-olds were subjected to an anamnestic and clinical examination of craniomandibular disorders. These individuals had been examined at the age of 12 years and this is one section of an extensive longitudinal investigation into the effects of malocclusion, and the effectiveness of orthodontic treatment. The children were originally selected on the basis of presence of malocclusion.
Signs of CMD were found in about half of the subjects. The proportion of individuals without any signs of CMD had decreased during the 4-year period. However, the number of subjects with severe signs remained very small. Changes in severity of CMD according to Helkimo's index of clinical dysfunction were mainly attributed to an increased prevalence of impaired TMJ function. An increase in prevalence of reported symptoms was found involving headache and joint sounds. The other recorded symptoms did not show any significant increase in prevalence. Mandibular mobility showed only minor changes from 12 to 15 years of age.
Temporomandibular joint sounds are often recognized as a clinical sign of temporomandibular disorders. The purpose of this study was to examine changes in the occurrence and resolution of these sounds in patients before and after orthodontic treatment with full fixed appliances. From a pool of 324 patients who came to a university postgraduate orthodontic clinic specifically for treatment of a malocclusion, 160 were examined before and after orthodontic treatment. When joint sounds were either reported or detected clinically, the patients underwent an audiovisual examination to more precisely and objectively record the occurrence and timing of the sound during mandibular opening and closing. No statistically significant difference could be found in the change in occurrence of joint sounds among patients treated with extraction and nonextraction treatment strategies. Overall, fewer patients had joint sounds at the end of the active stage of orthodontic treatment than before treatment. Also, fewer patients demonstrated reciprocal clicking after treatment than before treatment. Therefore it appeared that orthodontic treatment did not pose an increased risk for developing temporomandibular joint sounds irrespective of whether extraction or nonextraction treatment strategies were used. A progression of signs or symptoms to more serious problems was not apparent over the time period studied.
One-thousand-and-eighteen 12-year-old children were chosen by use of preselected screening criteria, and disproportionate sampling to participate in a longitudinal study into the dental and social effects of malocclusion. The data has now been used to investigate the effects of malocclusion and orthodontic treatment on craniomandibular disorders.
The sampling method was designed to create sub-groups large enough to study effectively the whole range of malocclusion, even those which have a low prevalence. This report will give baseline data in a longitudinal study. Intra-observer variability on recordings of signs of craniomandibular disorders was tested and reproducibility was found to be on an acceptable level.
Almost half the children had signs of CMD, but few of these were severe and overall, only a very small minority of children in this sample required treatment. A preliminary examination has been made into possible relationships between the signs and symptoms of CMD, and significant associations were found between headache and several clinical signs.
Two basic strategies for the timing of treatment for Class II malocclusions in children are common: (1) correction achieved in two phases, one during pre-adolescence (early treatment) and the other during the teen years; and (2) correction accomplished in one phase of active treatment during the adolescent years. The issues of efficacy and cost(risk)-benefit of these strategies have not been well delineated. Most clinical studies examining these issues have suffered serious methodological deficiencies, such as being retrospective, lacking adequate controls, and evaluating only successfully treated cases. However, despite a lack of objective data, clinicians have shown considerable interest in recent years in two-phase treatment. This paper reviews major issues of two-phase Class II treatment and concludes by delineating several important clinical questions which could be resolved by a carefully controlled prospective study.
The orthodontist has been both accused of causing and complimented for curing temporomandibular dysfunction. To better understand the origins of these conflicting opinions, a review of the orthodontic and temporomandibular joint journals was performed for articles published since 1966. A total of 91 publications that discussed the relationship between orthodontics and temporomandibular disorders was found, and these articles were divided in three categories: viewpoint publications, case reports, and sample studies. Among the areas scrutinized in each category was the method that has led to the diversity of viewpoints. From this analysis, the following conclusions were drawn: (1) viewpoint publications and case reports were excessively represented in comparison with the number of sample studies; (2) viewpoint publications and case reports described a wide variety of conflicting opinions on the relationship between orthodontics and temporomandibular disorders; (3) unlike sample studies, viewpoint publications and case reports have little or no value in assessment of the relationship between orthodontics and temporomandibular disorders; (4) sample studies indicate that orthodontic treatment is not responsible for creating temporomandibular disorders, regardless of the orthodontic technique; and (5) sample studies indicate that orthodontic treatment is not specific or necessary to cure signs and symptoms of temporomandibular dysfunction.
This longitudinal study monitored periodontal status in 20 adults and 20 adolescents undergoing fixed orthodontic treatment. Ten adults had generalized periodontitis and received periodontal treatment, including periodontal surgery, before orthodontic treatment. They also received periodontal maintenance at 3-month intervals during orthodontic treatment. The other 10 adults had normal periodontal tissues. Neither these latter adults nor the adolescents received periodontal maintenance during orthodontic treatment. Periodontal status was determined (1) at six standard sites before fixed appliances were placed (baseline), (2) at 1, 3, 6, 9, 12, and 18 months after appliances had been placed, and (3) 1, 3, 6, and 12 months after appliances had been removed. At each of these visits, these sites were assessed for plaque index, gingival index, bleeding tendency, and pocket depth. Loss of attachment between baseline and 3 months after appliances were removed and tooth loss were also determined. Complete data were obtained for 15 adolescents and 14 adults. During orthodontic treatment the adolescent group showed significantly more (p less than 0.05) periodontal inflammation and supragingival plaque than the adults; after appliances were removed, this pattern was no longer statistically significant. For loss of attachment, there were no significant differences among adolescents, adults with normal periodontal tissues, or adults with reduced but healthy periodontal tissues who had undergone treatment for periodontal disease. For tooth loss, three nonstudy site teeth with pockets deeper than 6 mm and/or furcation involvements were lost because of periodontal abscesses in the adult group treated for periodontal disease.
In this second report of a follow-up study of long-term adverse oral health effects of malocclusion it is assessed whether various occlusal and space anomalies imply an increased risk of caries. In 1965-66 malocclusion was recorded in 176 adolescents who were re-examined in 1986-87 at the age of 33-39 years. DMFS scores, in the dentition as a whole and in the segments of the dental arches, were compared between subjects displaying specified traits of malocclusion at both examinations and a comparison group comprising subjects without malocclusion at both examinations. No relationship was found between the malocclusion traits and caries prevalence.
The association between tooth irregularity and plaque accumulation, gingivitis and caries is somewhat controversial, primarily because of interplay of a number of factors which makes the determination of the role of irregularity difficult. This baseline study of 1015, 11-12-year-old children has attempted to unravel the effect of various interrelated factors using 4- way hierarchical analysis of variance. Preliminary analysis demonstrated that there was a modest but significant positive correlation (r=0.24p<0.001) between the subjects' mean plaque and mean irregularity indices. The main analysis, based on data from pairs of contralateral teeth, one of which was irregular and the other not, took into account differences between subjects, the position of the tooth in the mouth and whether the irregular tooth was on the toothbrushing hand side or not. Irregular teeth retained more plaque than straight teeth by a modest though statistically significant (p<0.05) extent, but no significant differences in the incidence of gingivitis or dental caries were found.
The aim of the present investigation was to evaluate the relationship of overjet to periodontal status. Detailed examinations of occlusal and periodontal characteristics were completed on 914 12-year-old children. Plaque indices, bleeding indices, and anterior overjet were recorded for each incisor tooth. There was a significant association between mean plaque scores and the extremes of overjet measurement, suggesting that tooth cleaning is more difficult in these cases. Also, it was apparent that for right-handed children, the plaque and gingivitis scores were lower on the left side of the mouth.
Information about previous orthodontic treatment and oral health is evaluated for 525 17 yr-olds and 175 21 yr-olds. Of these, 24.6% of the 17 yr-olds and 14.3% of the 21 yr-olds had received orthodontic treatment. Orthodontic treatment did not appear to have had any adverse effect on the level of periodontal disease, and caries prevalence in the orthodontically treated 17 yr-olds was less than in the untreated subjects.
This study evaluated the clinical periodontal status of persons who had completed orthodontic therapy at least 10 years previously (study) and compared the findings to those of adults with untreated malocclusions (control). Subjects in the study (n = 112; 63 female subjects, 49 male subjects; mean age 29.3 +/- 4.2 [SD] years) and control (n = 111; 62 female subjects, 49 male subjects; mean age 32.9 +/- 6.5 years) populations underwent a comprehensive periodontal examination that consisted of measurements taken at six points around the circumference of each tooth: (1) plaque, (2) visual inflammation, (3) bleeding after probing, (4) pocket depth, (5) gingival recession, and (6) loss of connective tissue attachment. Data from the individual measuring points were organized into 14 different combinations of either tooth types or surface locations; each was subjected to a four-way ANOVA partitioned on group (study vs. control), sex, socioeconomic status, and malocclusion type. The results showed that differences in age distribution within the groups were affecting the comparisons between the groups. Consequently, the groups were balanced for age and analyses were done to investigate group differences by means of multiple regression techniques. The comparisons showed no significant differences between the groups for any of the periodontal variables. It was concluded that orthodontic treatment during adolescence had no discernible effect upon later periodontal health.
A sample of 207 patients and their respective parents were surveyed to assess the influence various occlusal anomalies and other factors had had in stimulating a desire for orthodontic treatment. From the results obtained it is thought that more attention should be given to the particular occlusal and aesthetic deviations which are causing concern to the patient: assumptions based purely upon the presenting occlusal condition should be avoided.
It was shown that for the majority of patients the provision of orthodontic care was dictated largely by aesthetics but that the general dental practitioner exerted an appreciable influence on patient acceptance of treatment.
This article reports a 10-year longitudinal investigation of symptoms attributed to temporomandibular joint dysfunction in orthodontically treated subjects. The study was designed to test the prevailing assumption that orthodontic therapy is an etiologic factor in inducing TMJ dysfunction. Although the study was prospective in design, several unexpected methodologic complications limited the data analyses. Presumed joint dysfunction symptoms were assessed in orthodontically treated subjects. The presumed symptoms were subsumed under three categories: subjective symptoms, objective symptoms, and x-ray findings. The prevalence of symptoms was analyzed before treatment, 4 years later subsequent to retention, and 10 years after the initiation of the study. Comparisons of symptom frequencies were made between Begg and activator-treated subjects. The results of this investigation led to the following conclusions. In studying temporomandibular joint dysfunction, subjective symptoms, objective symptoms, and x-ray findings should be analyzed separately. Registration of symptoms during orthodontic treatment should probably be attributed to age changes rather than to treatment procedures. Begg Class I and Class II treatments do not reduce the percentages of symptoms registered. Begg Class I and Class II treatments do not affect the incidence of subjective symptoms. Begg Class I and Class II treatments do not affect the incidence of x-ray findings. Begg Class I and Class II treatments create higher percentages of objective symptoms after retention, but not in the long run (10 years). Ten years after the beginning of treatment, the initial differences in symptomatology between activator and Begg children no longer exist.
The effects of fraenal attachment, upper lip coverage, and mandibular vestibular depth on plaque and bleeding indices in the maxillary and mandibular anterior segments were studied in a group of 1015 school children aged 11.5 to 12.5 years. The position of the mandibular labial fraenum was relatively unimportant to plaque and mandibular gingivitis, but anterior fraenal attachment in the maxilla appeared to affect the retention of plaque and the degree of gingivitis. Maxillary and mandibular plaque and bleeding scores increased with decreasing upper lip coverage at rest. In the mandibular anterior segment, plaque and bleeding indices decreased with increasing vestibular depth. Further analysis demonstrated that fraenal attachment and vestibular depth and fraenal attachment and lip coverage were significantly associated. However, two-way analysis of variance indicated that the influence of fraenal attachment, vestibular depth, and lip coverage on plaque and gingivitis was independent. The influences of these soft tissue variables on plaque accumulation and gingivitis were of small clinical significance and not in themselves a justification for mucogingival surgery.
abstract – The relationship between crowding of teeth and gingivitis in mouthbreathers and nosebreathers was studied in a groupof 6- to 12-year-old children. The material consisted of fifty-five children with obstructed nosebreathing due to enlarged adenoids. Forty healthy children served as controls. Gingival conditions were registered in accordance with Löe & Silness. Crowding was assessed according to Lundström. The results indicated that in mouthbreathers there was a correlation between crowding and gingivitis, manifested in regions of the dentition most likely subjected to dehydration from mouthbreathing. For nosebreathers, the statistical method used did not reveal a correlation between crowding and gingivitis.
Utilization of orthodontic services may be influenced as much by the social and cultural setting as by objective criteria. The public's assessment of dental irregularity and its perceptions of the psychosocial implications of malocclusion may be critical factors in the utilization of available services. To test these assumptions, two communities with historic differences in the availability and utilization of orthodontic services were selected as survey sites (Lexington, Kentucky, and Cardiff, Wales). Three-hundred eighty-five sixth grade children (11 to 12 years of age) and 123 of their parents were interviewed concerning dental esthetics, treatment need, and knowledge about, attitudes toward, and value placed on orthodontic treatment. Although the Lexington respondents had greater personal and indirect knowledge about such services, they did not have more positive perceptions about treatment; nor did they value straight teeth more highly. There were no significant differences between the groups' judgement of dental esthetics or assessment of treatment need. The differences in utilization of services in the two communities could not be explained in terms of differences in attitude toward malocclusion and orthodontic treatment.
Studies on the relationship between malocclusion and mandibular dysfunction have been performed in adult subjects. Three samples have been examined: 56 patients with mandibular dysfunction, 389 men aged 21-54 years and 272 women aged 20-46 years.Approximately 25% of the men and the women had moderate or severe dysfunction according to the clinical dysfunction index. Fifteen per cent of the men and 34% of the women had subjective symptoms of dysfunction.Rotation of teeth was correlated with subjective symptoms of mandibular dysfunction in the men and the women. Angle class III malocclusion in the men and need for orthodontic treatment in the women showed the strongest correlation with the severity of clinical symptoms of dysfunction. Crossbite and frontal open bite were more prevalent in the patients with mandibular dysfunction than has been found in other studies. Most of these crossbites were associated with lateral displacements of the mandible between RP and IP. Bilateral crossbite showed a strong correlation to non-working side interference in the patients. The results also indicated that the aetiology of mandibular dysfunction is multifactorial.The implications of these results on orthodontic treatment indications and some aspects on when the treatment should be performed are discussed.Five case presentations are given to illustrate the possibilities of orthodontic treatment of adult patients with mandibular dysfunction.
The prevalence of temporomandibular (TM) disorders and the status of the functional occlusion in former orthodontic patients many years after treatment were evaluated in two independent clinical studies. In each study, the former orthodontic patients were compared to similar groups of adults with untreated Class I and Class II malocclusions. Both studies reported similar findings with regard to TM disorders; there was no statistically significant difference (p greater than 0.05) between the orthodontic and control groups in either study. The illinois study found a high prevalence of nonfunctional (balancing) contacts in both groups, while the Eastman study found a somewhat lower prevalence. Differences for most of the occlusal parameters between the orthodontic and control groups were not statistically significant in either study. The findings for these two studies are similar and suggest that orthodontic treatment performed during adolescence does not generally increase or decrease the risk of developing TM disorders in later life.
Certain features of malocclusion considered important in relation to periodontal health were analyzed in a study of 300 subjects. It was found that plaque and gingival inflammation were not related to vertical incisor overbite, horizontal incisor overjet or posterior cuspal interdigitation. Individual tooth irregularity measured as tilting, rotation, displacement and crowding had a low but statistically significant correlation with plaque, calculus and gingival inflammation. However, the study showed that these features of malocclusion are far less important than the extent of plaque and calculus deposits in the development of gingival inflammation.
The prevalence of bruxism, of subjective symptoms and of clinical signs of mandibular dysfunction was recorded in 7-, 11- and 15-year-old children (total number 402).
Bruxism was reported by 20–25% of the children and subjective symptoms of dysfunction (mostly occasional) by 16–25%, the frequency increasing with age. The prevalence of clinical signs of dysfunction also increased with age from about 30% in the youngest to 60% in the oldest age group. Most clinical signs were judged to be slight, the commonest occurrences were TMJ sounds and tenderness of the masticatory muscles to palpation. There was a positive correlation between subjective symptoms and clinical signs of dysfunction, as well as between reported bruxism and clinical signs of dysfunction.
The periodontal health of a group of ninety-six patients who had received comprehensive fixed-appliance orthodontic treatment during adolescence between 12 and 35 years previously was evaluated. Comparisons were made with a group of 103 adults who were similar with regard to race, sex, age, socioeconomic status, dental awareness, and oral hygiene status but had malocclusions that had not been orthodontically treated. There were no statistically significant differences in the general prevalence of periodontal disease between the two groups. However, more detailed analysis revealed that the orthodontic group had a greater prevalence of mild to moderate periodontal disease in the maxillary posterior and mandibular anterior regions of the mouth, as compared to the control group. The results suggested that orthodontic treatment in adolescence is not a major factor in determining the long-term periodontal health status. No significant amount of either damage or benefit to the periodontal structures could be directly attributed to orthodontic therapy. Conversely, the lack of orthodontic therapy in adolescence does not appear to influence subsequent development or nondevelopment of periodontal disease in adults.
The effects of orthodontic treatment on periodontal tissues in patients with severely reduced periodontal support were studied. A prerequisite for tooth movement was a reduction of periodontal inflammation by regular scaling and a high standard of oral hygiene. Surgical elimination of deepened periodontal pockets was not performed before orthodontic tooth movement. 20 patients took part in the study. The reduction of maxillary overjet was performed with light forces by elastics from removable orthodontic appliances. Oral hygiene, gingival inflammation, pocket depth and the alveolar bone level were recorded before hygiene treatment and before and after orthodontic treatment.
As a result of the hygiene treatment, the Plaque Index and Gingival Index scores were markedly reduced. The values for pocket depth showed no major change. When comparing mean values for proximal bone level measurements before and after orthodontic tooth movement no difference could be seen. The individual proximal bone level values remained unchanged for every second surface. The maximum deterioration in bone level, measured as a percentage of tooth length, during orthodontic treatment was 10% in 9 surfaces out of 142.
Provided careful preorthodontic hygiene treatment of the existing advanced periodontal disease is given and the forces are kept within physiological limits, the results from this clinical study show that no increased progression of marginal periodontitis will occur due to orthodontic tooth movement.
This study investigated the self-perception of malocclusion among 506 15 and 16-year-old children. The Aesthetic Component of the Index of Orthodontic Treatment Need was used to allocate each subject to 'no aesthetic need' for treatment, 'borderline aesthetic need', or 'definite aesthetic need' for treatment subgroups. The results indicate that adolescents who were scored by a trained examiner (using IOTN) as having similar dental aesthetics have similar perceptions of their malocclusion irrespective of their gender or social background.
Orthodontics has seen a change in perspective in the United Kingdom. The patient, provider and purchaser are considered in sequence when considering this change. The changes in oral health, wider knowledge and greater expectations have affected the patient's perspective. While, for the provider, changes in diagnosis, linked with outcome and stability of treatment, have resulted in the development of indices of treatment need and outcome and the need to consider intervention, based on health grounds, plus equity of care. The purchaser needs appropriate technology and manpower available to provide a service in the international perspective of limited resources for health care and has an increased interest in equity of care provided using state funding.
In this second of two articles, the role of occlusion and malocclusion is assessed with respect to orthodontics and temporomandibular disorders (TMD). Some have suggested that malocclusion may cause TMD, or that by introducing a form of malocclusion, orthodontic treatment could be iatrogenic. Pertinent evidence relating to these issues will be assessed.
Orthodontists are concerned about the possibility of a link between the treatment they provide and temporomandibular disorders (TMD). The purpose of this article was to review the literature relating malocclusion and orthodontic treatment to problems of the temporomandibular joint (TMJ) and surrounding anatomy. In Part 1, the relationship of orthodontic treatment to TMD is discussed. In Part 2, the relationship of TMD to malocclusion will be addressed.
When treating children, important ethical issues may arise relating to the best interests of the child and decision making for minors. The case of a child with a cleft lip and palate whose parents failed to bring her in for medically indicated orthodontic care is presented. Ethical features of the case are discussed, including the need to benefit the patient, avoid harm, and respect the preferences of the parents. Ethical codes of the American Dental Association and American Medical Association are referenced. Ethical dilemmas include the conflict between the orthodontist's obligation to the child and the need to respect parental autonomy. Parental autonomy is respected up until the point at which significant harm to a child may result. The orthodontist's primary ethical responsibility is to the child, not the parents. The orthodontist providing medically indicated care should involve the craniofacial team or hospital social worker when parental decision making is in question.
The aim of this study was to aggregate the risk of traumatic dental injury due to overjet using several published papers and performing a meta-analysis on the results. The 11 articles involved in this investigation were identified by a literature search of Medline (1966-1996) and Exerpta Medica (1985-1996) databases using predetermined keywords, and inclusion and exclusion criteria. In order to assess the quality of each paper, a methodological checklist for observational studies was developed resulting in a score between 0 and 100. The relative risk of overjet, compared with a reference, was expressed as an Odds Ratio (OR). For each study, the OR was computed using the data presented and, subsequently, these ORs were pooled across studies. The effect of confounders (i.e. age, gender), which could bias the relationship between overjet and dental injury was taken into account. Furthermore, the influence of quality of the study on the pooled OR was addressed. The average methodological score was 41. From the results, it can be concluded that children with an overjet larger than 3 mm are approximately twice as much at risk of injury to anterior teeth than children with an overjet smaller than 3 mm. The effect of overjet on the risk of dental injury is less for boys than for girls in the same overjet group. In addition, risk of injury of anterior teeth tends to increase with increasing overjet size. Furthermore, the pooled OR does not seem to be affected by the quality of the studies.
This study investigated incisor trauma in children with overjets greater than or equal to 7 mm who were enrolled in a clinical trial of 2-phase early orthodontic treatment for Class II malocclusion. In phase 1, children were randomly assigned to treatment in the mixed dentition with either modified bionator or combination headgear or to a group in which treatment was delayed until the permanent dentition. All children received comprehensive treatment during phase 2 if necessary. At the start of the trial, 29.1% of the patients had already had some incisor trauma. This was not significantly related to dental developmental age. During the trial, there was an increase in trauma in all 3 groups, but the magnitude of this increase was not significantly greater in the group for which treatment was delayed until the permanent dentition. This might suggest that orthodontic intervention aimed at reducing trauma should begin very soon after the eruption of the maxillary incisors. However, the injuries tended to be minor, and the expected cost of treatment related to incisor trauma was small compared with the expected additional cost of a 2-phase orthodontic intervention.