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Remote Monitoring and “Tele-orthodontics"- Concept, Scope and Applications
Abstract
Tele-orthodontics is a broad term that encompasses remote provision of orthodontic care, advice, or treatment via information technology. The Purposes of the article were two-fold: (1) to review the rather new concept, applications and scope of teleorthodontics, and (2) to present preliminary results of a study with and without Dental Monitoring™ (DM) usage on appointment efficiency, patient perspectives and patient demographics. The sample was comprised of 74 consecutively treated Invisalign® patients using DM™ and 85 consecutively completed Invisalign® patients. An online questionnaire was given to the DM™ group to assess the patients’ perspective on the ease of use and benefit to treatment experience using a 5-point Likert scale. Also requested was a list of 5 benefits and problems while using DM™. Independent t-tests were used to determine any inter-group differences in, number of appointments and age; a chi-square test was used for differences between genders. Significance was set at P ≤ 0.05. Mean number of appointments was significantly lower by 1.68 appointments for DM compared to control (P < 0.001). Age averaged 3.2 years younger for the DM group (P < 0.05). More males used DM than the control group (31.6% vs 16.7%, P < 0.05, respectively). The mean Likert scale rating for “ease of use” was 4.31 out of 5.0, while benefit to treatment experience rating was 4.4. The most oft-mentioned perceived benefits were “better communication” (47 times), “increased convenience” (44 times), “reduced number of appointments” (40 times), and “ease of use” (38 times). The most oft-mentioned problems were related to the “difficulty of taking scans” (27 times) and “reduced communication” (12 times). Preliminary study results suggest the number of appointments may be reduced with Dental Monitoring. In addition, there was a positive patient perception on the use of DM.
... The majority of the included studies used DM in addition to an orthodontic treatment with aligners (Caruso et al., 2021;Hannequin et al., 2020;Hansa et al., 2018Hansa et al., , 2020Hansa et al., , 2021Sangalli et al., 2022b). Two studies used DM in the remote monitoring of patients undergoing treatment with a rapid palatal expander (RPE) (Kuriakose et al., 2019;Moylan et al., 2019). ...
... Five studies (45.5%) investigated the effectiveness of DM in reducing treatment duration, number of emergency appointments and number of in-office visits. The three studies that analysed the influence of DM on treatment duration showed no significant difference (Hansa et al., 2018(Hansa et al., , 2020(Hansa et al., , 2021. However, it should be noted that all of these studies were derived from the same group of researchers. ...
... On the contrary, four demonstrated that a significant fewer number of in-office visits was needed when DM was integrated to the standard orthodontic care. Such reduction was in the range of 1.68-3.5 appointments over an orthodontic therapy with aligners (Hansa et al., 2018(Hansa et al., , 2020(Hansa et al., , 2021. Nevertheless, the baseline characteristics of the participants were not always statistically similar between the compared groups. ...
Background: Dental monitoring (DM) constitutes a recent technological advance for the remote monitoring of patients undergoing an orthodontic therapy. Especially in times of health emergency crisis, the possibility of relying on remote monitoring could be particularly useful.
Objectives: To assess the effectiveness of DM in orthodontic care.
Eligibility: Studies conducted on healthy patients undergoing orthodontic care where DM was applied, assessing a change in treatment duration, emergency appointments, in-office visits, orthodontic relapse, early detection of orth- odontic emergencies and improvement of oral health status.
Information sources: PubMed, Web of Science and Scopus were searched for publications until November 2022. Risk of bias: Quality assessment was performed with the STROBE Checklist.
Data extraction: Data were extracted independently by two reviewers, and discrepancies were resolved with a third reviewer.
Included studies: Out of 6887 records screened, 11 studies were included.
Synthesis of results: DM implemented to the standard orthodontic care was found to significantly decrease the num- ber of in-office visits by 1.68–3.5 visits and showed a possible trend towards improvement of aligner fit. Conversely, evidence does not support a reduction of treatment duration and emergency appointments. The assessment of the remaining variables did not allow any qualitative synthesis.
Conclusions: This review highlighted that DM implemented to standard orthodontic care can significantly decrease the number of in-office visits and may potentially result in an improved aligner fit. Due to the low quality of most of the included studies and the heterogeneity of the orthodontic system where DM was applied, studies with different investi- gation team and rigorous methodology are advocated.
... Tele-ortodonti, ortodontik muayenenin, tedavinin ve hasta açısından ortodontik bakımın bilgi teknolojisi yoluyla doğrudan kişisel temas yerine, uzaktan sağlanmasını kapsayan geniş bir terimdir. 20 Ortodonti hizmetlerinin hastalara ulaşmasını kolaylaştıran tele-ortodonti, diş hekimliğinin dikkatle izlenmesi gereken bir alanıdır. 15 Gelişmiş hasta uyumu ve sorunlara erken müdahale edilmesi nedeniyle klinik ziyaretlerin azalmasına, daha kısa tedavi süresine ve proaktif yeniden izlemeye olanak sağlamaktadır. ...
... Üç entegre platformdan oluşur: hasta için bir mobil uygulama, patentli bir hasta izleme algoritması ve hastaların verilerinin alındığı web tabanlı bir Doctor Dashboard. 4,20,21,27 Mobil DM uygulaması şu anda Android ve iOS işletim sistemleri için mevcuttur. Uygulama hastaya, DM tarafından önerilen ve tedavi ihtiyaçlarına göre iyileştirilen bir programa göre özel yanak ekartörü ile fotoğraf çekme sürecinde rehberlik eder. ...
... Uygulama, hastanın geçmiş fotoğraflarını gözden geçirmesine, tedavinin ilerlemesini gözlemlemesine, demo modunda pratik yapmasına ve doktorundan bildirim almasına olanak tanır. 20 Dental Monitoring, doktorların ilk konsültasyondan ilerleyen döneme kadar bir ortodontik tedavinin ilerleyişi üzerine kontrol sağlamasını sağlayan bir sistemdir. Optimize şemalar için ilk kez randevular arasında diş hareketi ölçülür, miktarı belirlenir ve ortodontiste iletilir. ...
ÖZET
Dijital ve mobil dünyada ortodonti alanında da teknolojinin dönüştüğü, çığır açan olasılıklarınsunulduğu bir döneme giriyoruz. Hastaların dişlerinin klinik dışından, ortodontistler tarafından uzaktanyönlendirilerek belirli bir oranda tedavi edilmesi bile artık mümkün. Tele-tıbbın bir dalı olan tele-dişhekimliği ve tele-ortodonti hastalara gülümsemelerini mümkün olan en güvenli ve en uygun şekilde kontrol etme imkanı vermeye çalışan ortodonti biliminin geleceğinin kaçınılmaz bir parçası olarak önümüzde duruyor.
Anahtar Kelimeler:Teletıp; diş hekimliği; ortodonti; COVID-19
ABSTRACT
In the digital and mobile world, we are entering a period in which technology transformsand groundbreaking possibilities are offered in the field of orthodontics. It is now possible to treat the teeth of the patients to a certain extent by directing them remotely by orthodontists outside the clinic.Tele-dentistry and tele-orthodontics, which are a branch of tele-medicine, stand before us as an inevitable part of the future of orthodontics, which tries to give patients the opportunity to control their smiles in the safest and most convenient way possible.
Keywords: Telemedicine; dentistry; orthodontics; COVID-19
... Patient's progress and compliance can be monitored through in-office visits at certain time intervals. However, this interval is not necessarily ideal for every patient [4]. To overcome this limitation, Dental Monitoring® (DM, Dental Monitoring, Paris, France) is introduced as artificial intelligence (AI) driven remote monitoring, which analyzes tooth movement, oral hygiene, and the condition of orthodontic appliances [1,3,5]. ...
... Dentists will be notified after the patient's intraoral photos have been analyzed by the AI algorithm. Dentists can also communicate with the patient through the application [4,9]. ...
... Overall, the average patient satisfaction with DM was 4.25 from a 5-point Likert scale. 12% of patients were not satisfied with the use of DM and prefer in-office visits [4] 1. DM users indicated the DM application was easy to use with 86% of patients indicating its use was "easy" or "very easy" with an average of 4.31 out of 5.0. The use of DM was considered beneficial in treatment with 84% of patients indicating its use was "useful" and "very useful" with an average of 4.4 out of 5.0 The most frequently mentioned benefit of patients using DM was "better communication" (mentioned by 47 patients), "increased comfort" (mentioned by 44 patients), and "decreased in-office visits" (mentioned by 40 patients) The most common problem experienced by DM users is "difficulty in performing scans" (mentioned by 27 patients) ...
Background: Orthodontic treatment success does not only depend on proper diagnosis and treatment, but also on patient’s compliance. Patient’s progress and compliance can be monitored through in-office visits at certain time intervals. However, this interval is not necessarily ideal for every patient. Purpose: To overcome this limitation, Dental Monitoring® (DM) is introduced as artificial intelligence (AI) driven remote monitoring, which analyzes tooth movement, oral hygiene, and the condition of orthodontic appliances. This study aimed to describe the clinical application of DM based on the number of in-office visits, duration of treatment, number of refinements, stability of retention phase, tooth movement, patient's oral hygiene, and patient’s subjective perception regarding DM. Review: Based on five articles included, the use of DM during orthodontic treatment had several advantages including the increase of patient’s compliance on maintaining oral hygiene and significant reduction of in-office visits, thus increasing the treatment’s effectiveness and comfort for patients. Duration of treatment and number of refinements that do not differ significantly between DM and non-DM users are considered as DM’s other advantages as it could reduce in-office visits without compromising treatment’s effectiveness. Orthodontic relapse can also be identified hence severe relapse can be prevented. Conclusion: The clinical application of DM can reduce in-office visits, improve oral hygiene and retention stability. However, the use of DM must be carefully considered to prevent decline in doctor-patient relationships
... The six reasons for gaps are listed and reviewed to generally help prevent contributions to refinements. [7][8][9][10][11][12] This includes recognizing the benefit of a beveled gingival bond, that is flash-free for a crowded and palatally displaced upper lateral incisor and that it tips with aligners from a center of rotation 6 resulting in relative intrusion away from the aligner. It helps to pre-plan space first and add labial root torque stepwise with tipping and good compliance. ...
... 6-12 aligners sets (every 6, 12, 18, 24, etc) for efficiency. 12 In addition, place simple "Hold" stickers on the package of the last set of e.g. 6 sets of aligners to remind patient not to miss their appointment for their mid-treatment IPR. The last aligner provided to the patient divided by the total number of aligners is always recorded at each appointment in the electronic chart e.g. ...
... 4. Uncontrolled tipping: Uprighting proclined L1s with relative extrusion can also be controlled by aligner coverage. 12 Severe incisor proclination with aligner tends to produce relative intrusion (U2 gaps and loss of aligner tracking). 5. Molar distalization: Effective with maxillary segmental distalizers (MSD) in 4-6 months. ...
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... 7th generation adhesives are predictable one-step, onebottle systems for the complete etching and bonding of all enamel and dentin surfaces with no rinsing. Excellent dentin bonding (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) and similar micromechanical adhesion strength to both prepared and unprepared enamel allow effective use for direct and indirect composite. ...
... In managing traumatic dental injuries, intra-oral radiographs with three different angulations, horizontal angle (90°) with central beam through the involved tooth, lateral view from the mesial and distal aspects of the involved tooth 27 , are usually sufficient to assess most of the dento-alveolar injuries. They must therefore be used during the initial evaluation and follow-up visits. ...
... Three-dimensional imaging (both CT-scan and CBCT), despite delivering a higher radiation dose, has a great potential to help in the diagnosis and treatment planning of dental trauma associated with maxillofacial injuries 25,29 . In fact, it allows better visualization of the traumatized dento-alveolar structures by eliminating superimpositions of the adjacent anatomic structures 27 . ...
... Similarly, those who travel frequently or have busy schedules can bene t tremendously from remote monitoring. In this way, patients are not required to attend the of ce physically until an adjustment is necessary, which for the busy patient and family can make treatment less taxing on their time and transportation costs, and for the orthodontic of ce it can free up signi cant chair time commonly used for progress checks [42]. ...
... It allows practitioners to remotely monitor patients' treatment progress. It consists of three integrated platforms: a mobile app for the patient, a patented movement tracking algorithm, and a web-based Doctor Dashboard where updates of the patients' progress are received [42,43] (Fig. 7.35 [42]). ...
... It allows practitioners to remotely monitor patients' treatment progress. It consists of three integrated platforms: a mobile app for the patient, a patented movement tracking algorithm, and a web-based Doctor Dashboard where updates of the patients' progress are received [42,43] (Fig. 7.35 [42]). ...
Digital technology has already become indispensable to modern dentistry, and the use of 3D technology in orthodontics has increased in recent years. The developments and introduction of intraoral and facial scanners, digital radiology, and cone-beam computed tomography (CBCT) have transformed diagnosis and treatment planning from a traditional two-dimensional (2D) approach into an advanced three-dimensional (3D) technique. A more recent breakthrough is the advancement of computer-aided design and computer-aided manufacturing (CAD/CAM) and 3D printing technology that is utilized to design and create “personalized” orthodontic appliances. Such systems not only shorten treatment time, making cases more predictable and less labor-intensive, but allow doctors and patients to preview virtual results before treatment begins, thus facilitating communication, understanding, cooperation, and case acceptance. This chapter discusses the latest technologies used in orthodontics such as imaging, scanners, 3D printed and custom-made appliances, apps, and tele-orthodontics.
... Five studies assessed the benefits of teleassistance in orthodontics for the management of patients at a distance. They all stated that teleorthodontics has the potential to provide significant and determinant help even if further investigation is deemed necessary [19][20][21][22][23]. ...
... Five papers evaluated the efficacy and reliability of orthodontic teleassistance in the diagnosis treatment and follow-up of patients [24][25][26][27][28]. Five studies assessed the benefits of teleassistance in orthodontics for the management of patients at a distance. They all stated that teleorthodontics has the potential to provide significant and determinant help even if further investigation is deemed necessary [19][20][21][22][23]. ...
... Similarly, patients who are on orthodontic treatment during the COVID 19 pandemic period can benefit tremendously from remote monitoring, avoiding unnecessary follow-up appointments. Patient monitoring through this simple software may also improve treatment efficacy by avoiding late detections of problems such as debonded brackets, broken ligatures, non-tracking aligners, and are therefore able to solve the problem in the early stage [22]. ...
Background:
COVID-2019 spread rapidly throughout the world from China. This infection is highly contagiousness, has a high morbidity, and is capable of evolving into a potentially lethal form of interstitial pneumonia. Numerous countries shut-down various activities that were considered "not essential." Dental treatment was in this category and, at the time of writing, only non-deferrable emergencies are still allowed in many countries. Therefore, follow-up visits of ongoing active therapies (e.g., orthodontic treatment) must be handled taking special precautions. This literature review aims at reducing in-office appointments by providing an overview of the technologies available and their reliability in the long-distance monitoring of patients, i.e., teledentistry.
Methods:
A literature review was made according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. Randomized clinical trials, cross sectional, observational, and case-control studies were evaluated with the Mixed Methods Appraisal Tool for quality assessment and study limitations.
Results:
A primary search found 80 articles, 69/80 were excluded as non-relevant on the basis of: the abstract, title, study design, bias, and/or lack of relevance. Twelve articles were included in the qualitative analysis.
Conclusions:
Teleorthodontics can manage most emergencies, reassuring and following patients remotely. The aim set by dental teleassistance was met as it reduced patients' office visits whilst maintaining regular monitoring, without compromising the results. Although our preliminary findings should be further investigated to objectively evaluate the efficacy, cost-effectiveness, and long-term results, we are confident that teleassistance in orthodontics will have a role to play in the near future.
... Teleorthodontics and remote monitoring are an imminent reality which permits orthodontists to proactively monitor their patients with virtual examinations to supplement chairside appointments [1,2]. Although tainted with negative connotations associated with the direct to consumer business model [3,4], there are some tremendous advantages of remote monitoring to the practice of orthodontics [5]. ...
... Hansa et al. [2] found a generally positive patient perception and experience using DM, with the most common complaint being unable to take DM scans correctly. Common benefits mentioned by patients included better communication with the orthodontist, reduced number of office visits, and increased convenience. ...
... A reduction of the number of appointments by 2.26 visits (23%) over the treatment duration in the DM group was both statistically significant and clinically relevant, thus rejecting the null hypothesis. The reduction in appointment number using DM also confirms the results of the pilot study by Hansa et al. [2] and an unpublished thesis [16]. A reduction in appointments reduces social costs in general. ...
Background:
The aims of the study were to compare the effects of Invisalign® with and without Dental Monitoring® (DM) GoLive® on the following parameters: treatment duration, number of appointments, number of refinements, total number of refinement aligners, and time to initial refinement. The patients' perspectives on Dental Monitoring® were also evaluated using an online questionnaire. A sample of 155 consecutively treated Invisalign® patients (67 control, 88 DM) fit the inclusion and exclusion criteria.
Results:
The two groups were homogeneous (P > .05) for age, gender, angle classification, Little's Irregularity Index, and number of initial aligners. The DM group had significantly fewer office visits compared to the control (7.56 vs 9.82; P < .001). There were no significant differences between the DM and control groups respectively pertaining to treatment duration (14.58 vs 13.91), number of refinements (1.00 vs 0.79), number of refinement aligners (19.91 vs 19.85), and time to first refinement (9.46 vs 9.97). Questionnaire results showed that 68.8% (44 respondents) indicate that DM scans were "easy" or "very easy" to perform while 16 responders (25%) found it "difficult" or "very difficult." 71.9% (46 responders) were "satisfied or very satisfied" with the level of communication with the orthodontist using DM and 16% (10 responders) were "dissatisfied" or "very dissatisfied." The mean duration observed by patients to take a scan was 5.16 ± 3.6 min. Eighty-eight percent (56 responders) of patients prefer few office visits as possible, while 12% (8 responders) would actually prefer additional office visits. Overall, the mean satisfaction of patients with DM was 4.25 on the 5-point Likert scale.
Conclusion:
The DM group had a significantly reduced number of appointments (7.56) compared with the control group (9.82) (a reduction of 23%) over the treatment duration. There were no significant differences between the two groups in treatment duration, number of refinements, number of refinement aligners, or time to 1st refinement. Overall, DM was well received by patients. However, there was a small percentage (usually less than 15%) that was generally unsatisfied with DM in varying aspects and preferred more frequent, traditional office visits.
... Orthodontic treatment complemented by virtual checkups has been strengthened with the emergence of orthodontic aligners, due to remote monitoring technology being applicable for assessing the advance in treatment without the need for faceto-face appointments. 2 Remote monitoring systems are part of Artificial Intelligence-Driven Remote Monitoring (AIRM). 3 At its forefront, is the Dental Monitoring ® software (DM, Montreal, France), a software used on smartphones that allows the patient to accurately capture their teeth, in photos and videos, with the aid of a patented cheek retractor. ...
... The incorporation of this tool seems to have increased with the advent of aligners. In conventional orthodontics, it seems to be an excellent option for controlling side effects, detecting passive arches, monitoring tooth eruption and identifying bracket fractures2,11 . DKB, Santos MCC, Normando D -Is teledentistry effective to monitor the evolution of orthodontic treatment? ...
Introduction
With the advent of COVID-19, teledentistry and remote monitoring have become an imminent reality that allows orthodontists to monitor orthodontic treatment through virtual checkups, which complement in-office appointments.
Objective
To evaluate the effectiveness of using teledentistry in monitoring the evolution of orthodontic treatment.
Material and Methods
Searches were performed in on-line databases. PECO strategy focused on comparing orthodontic patients exposed and not exposed to teledentistry. Searches and data extraction followed PRISMA guidelines. The assessment of the risk of bias and the certainty of the evidence was performed using the ROBINS-I and GRADE tools, respectively. A meta-analysis was also performed.
Results
Out of 1,178 records found, 4 met the criteria and were included in the qualitative analysis. The risk of bias for follow-up assesment in aligner treatment was low to moderate; while for interceptive treatment, it was high. Studies are favorable to the use of teledentistry. The meta-analysis was performed with aligners studies only, due to heterogeneity. The certainty of the evidence was considered very low.
Conclusion
With very low certainty of evidence, teledentistry using Dental Monitoring® software is effective as an aid in monitoring the evolution of interceptive orthodontic treatment (high risk of bias) and, especially, treatment performed with aligners (low to moderate risk of bias). The meta-analysis evidenced a reduction in the number of face-to-face appointments (mean difference = −2.75[−3.95, -1.55]; I²=41%; p<0.00001) and the time for starting refinement (mean difference = −1.21[−2.35, -0.08]; I²=49%; p=0.04). Additional randomized studies evaluating corrective orthodontic treatment with brackets and wires are welcome.
Keywords:
Teledentistry; Orthodontics; Systematic review
... Teleorthodontics is the use of telecommunications and information technology to facilitate public awareness campaigns and provide patients with particular orthodontic information [39,40]. Hansa et al. carried out a study to assess the use and range of tele-orthodontics [41]. The goal was to examine the impact of appointment efficiency, patient viewpoints, and patient demographics on the use of the remote monitoring software (Dental Monitoring, DM). ...
... Future orthodontic residents may receive valuable orthodontic teaching through virtual reality (VR) and augmented reality (AR) [42,43]. Although AR and VR in orthodontics are still in their infancy, advancements have been made in other dental specialties [41]. Haptic devices that considerably improve skills in tooth preparation by letting the operator feel the force during treatment. ...
Citation: Alam, M.K.; Abutayyem, H.; Kanwal, B.; A. L. Shayeb, M. Future of Orthodontics-A Systematic Review and Meta-Analysis on the Emerging Trends in This Field. J. Clin. Med. 2023, 12, 532. https://doi. (M.K.A.); h.abutayyem@ajman.ac.ae (H.A.) † These authors contributed equally to this work. Abstract: Technology is rapidly evolving in the modern world, and the accompanying developments due to its influence are shaping each and every aspect of our life, with the field of orthodontics being no exception. This systematic review and meta-analysis aimed to examine such trends in orthodontics and hypothesize which ones would emerge and continue in the near future. After a thorough search of online journals using keywords such as "3D printing," "Aligners," "Artificial intelligence," "Future trends," "Orthodontics," and "Teleorthodontics" across databases of PubMed-MEDLINE, Web of Science, Cochrane, and Scopus, a total of 634 papers were initially recovered. Technological advancements in 3D printing, Computer-aided design and Computer-aided manufacturing (CAD/CAM), biopolymers and Teleorthodontics were the most important categories of development seen across the 17 studies that we selected for our review. All the investigations selected for this systematic review depicted aspects of orthodontics that were influenced by rapid technological changes and could potentially become mainstream in the coming times. However, caution was sought to be observed in the usage/adoption of some of these trends, with social media usage amongst both patients as well as orthodontists being a prime example of this.
... Hal ini menjadi hambatan pada pasien yang memiliki jadwal yang padat dan jarak yang jauh dari rumahnya ke klinik dokter gigi.5 Dalam konteks ini, ortodontik berupaya untuk maju; penggunaan teleortodontik yang merupakan istilah yang digunakan untuk perawatan ortodontik jarak jauh dengan melalui media teknologi informasi, bukan secara langsung melalui kontak perseorangan pada dokter gigi. 5 Layanan teleortodontik dinilai lebih efisien dalam perawatan ortodontik berbasis internet pada pasien jarak jauh. Oleh karena itu, penulis tertarik mengkaji lebih dalam mengenai teleortodontik sebagai solusi terkini dalam perawatan maloklusi. ...
... Hal ini dapat menghemat waktu pasien dan meningkatkan kenyamanannya. 5 Aplikasi yang penting untuk memfasilitasi teleortodontik adalah Dental MonitoringTM (DMTM) yang membantu pasien mencatat oklusi secara tepat dengan menggunakan smartphone. Saat ini teknologi menjadi media utama dengan menggunakan aplikasi dalam smartphone. ...
Introduction: Malocclusion is a dental health problem that has a high prevalence rate. According to WHO, the periodic ranking is below dental caries and periodontal disease. The prevalence in Indonesia reaches 80%. Orthodontic treatment requires intensive time to control every month. This is an obstacle forcertain patients who have busy schedules and great distances from the clinic to the dentist clinic. In this context, orthodontics was invited to go forward using tele-orthodontic devices which is a term used for long-distance orthodontic treatment through information technology media, not through direct contact with individual contacts. Objective: To examine more deeply about tele-orthodontics as a solution in the treatment of malocclusion. Discussion: Dental MonitoringTM is a software-based program that enables practitioners to monitor the development of patient care remotely. Another advantage is closer management through remote monitoring, saving time, transportation costs, and increasing patient comfort. Conclusion: Tele-orthodontics can be used as a current solution to treatment for malocclusion.
... A face-to-face initial consultation instills a kind of trust that would otherwise be impossible to gain with just a mere remote consultation. [18] It would also be questionable as to how many patients given such pricey methods to take "suspect quality" intraoral selfies would follow through? Compliance has always been a concern in orthodontic treatment and has been one of the most important factors determining treatment success. ...
... [19] Orthodontics presents a very different situation wherein cooperation is highest at the start of treatment and that may be true with these "monitoring" devices and procedures. [18] When compliance fades and we may need the help from "tele-ortho," odds are tilting away from our favor that we will get it. ...
Teledentistry has proven effective in practically all dental fields. It also allows access to inaccessible and underdeveloped locations. Better treatment outcomes were documented in patients treated by an orthodontist supervised by teledentistry than by a general dentist with minimal orthodontic experience alone. It may also help to focus referrals to specialists and weed out those who do not need them. But, on a critical note, a doctor-patient relationship is much more than a business transaction. A face-to-face initial consultation instills trust that a remote session cannot. Teledentistry includes professional networking of doctors. This contact includes digital information exchange, CPD programs, case discussions, and analysis that bring dentists from all around the world together to improve patient care. Teledentistry has not only spanned the distance between dentists worldwide, but has also served as a conduit between customer (patient) and manufacturer. This spawned Direct to Consumer (DTC) dentistry, sparking substantial debate among dentists worldwide. In DTC dentistry, inadequately trained customers conduct complex procedures on themselves with minimal guidance of a dentist. One of the major issues today is the general availability of clear aligners to patients without the requirement for an intermediary skilled orthodontist. The American Association of Orthodontists (AAO) has publicly questioned the validity of Smile Direct Club, a private firm that dominates the DTC industry. European Federation of Orthodontic Specialists Association, on the other hand, has sponsored a joint declaration with the representative orthodontic associations in Europe to highlight and alert patients about the potential risks of DTC products. Unfortunately, public shaming hasn't slowed commercialization of DTC firms. Teledentistry has been a boon for healthcare, but a nightmare for our profession, raising fundamental questions like what is the difference between a customer and a patient? Is dentistry a just another discipline of cosmetics? Is teledentistry making us less connected with our patients?
... EUC-IRB-19.01.15). A power analysis using the number of appointments as the primary outcome was performed on the basis of the results of Hansa et al. 15 Using an alpha of 0.05 and 80% power, it was determined a total sample size of 48 was required. However, to obtain adequate power for determining true differences in treatment duration and the other objectives with unknown or smaller effect sizes, a larger sample was required. ...
... A reduction of the number of appointments by 3.5 visits (33.1%) over the treatment duration in the DM group was both statistically significant and clinically important. The reduction in the number of appointments using DM also confirms the results of the pilot study by Hansa et al. 15 Clinicians may opt to embrace this technology purely for increasing office efficiency alone. This technology is especially beneficial if a practice is at maximum capacity and requires greater efficiency to increase revenue. ...
Introduction
The effects of Invisalign clear aligner treatment with and without Dental Monitoring (DM) were compared for treatment duration, number of appointments, refinements and refinement aligners, and accuracy of Invisalign in achieving predicted tooth positions (aligner tracking). The null hypothesis was that there are no differences between Invisalign with and without DM in these parameters.
Methods
A sample of 90 consecutively treated Invisalign patients (45 control, 45 DM) fitted the inclusion and exclusion criteria. Treatment duration, number of refinements, number of refinement aligners, time to first refinement, number of appointments, number of emergency visits, and accuracy of predicted tooth movement were observed for differences.
Results
The 2 groups were homogeneous (P >0.05) for sample size, age, gender, Angle classification, maxillary and mandibular irregularity index, and the number of initial aligners. There was a significant (P = 0.001) reduction in the number of appointments by 3.5 visits (33.1%) in the DM group. There was also a significant (P = 0.001) reduction in the time to the first refinement (1.7 months) in the DM group. Compared with Invisalign predicted tooth positions, actual tooth positions were statistically (P <0.05) more accurate for the DM group for the maxillary anterior dentition in rotational movements and mandibular anterior dentition for buccal-lingual linear movement. Invisalign therapy without DM was closer to predicted tooth positions for the maxillary posterior dentition for the tip. None of these differences surpassed the clinically significant thresholds (>0.5 mm or >2°); however, the DM group achieved this in 1.7 fewer months.
Conclusions
DM with Invisalign therapy resulted in a reduced number of appointments by 3.5 visits (33.1%). The DM group also achieved a clinically similar accuracy in obtaining predicted tooth movements compared with the control group in 1.7 fewer months, indicating improved aligner tracking in the DM group.
... In this context, it is important to consider remote monitoring and teleorthodontics concepts and applications, such as the remote provision of orthodontic care, advice, or treatment using information technology. 28 Many of the urgencies reported by the orthodontists in this survey could be solved with remote consultations without the need of a scheduled urgency appointment, by teleorthodontics. 28 However, in Brazil, this type of attendance was not approved by the Federal Council of Dentistry when the survey was performed. ...
... 28 Many of the urgencies reported by the orthodontists in this survey could be solved with remote consultations without the need of a scheduled urgency appointment, by teleorthodontics. 28 However, in Brazil, this type of attendance was not approved by the Federal Council of Dentistry when the survey was performed. This regulation of the distance dental practice, mediated by technologies, in Brazil was approved on June 4, 2020. ...
Introduction
The present study aimed to evaluate the most common urgencies and emergencies in orthodontics during the coronavirus disease 2019 (COVID-19) pandemic and to assess how orthodontists in Brazil were dealing with patients and challenges.
Methods
Early in 2020, as the COVID-19 pandemic spread around the world, routine dental care was suspended in many countries, and only patients needing urgent or emergency care could be seen. During this period, orthodontists in Brazil were invited to participate in an anonymous online survey. Over 48 hours (May 1-3, 2020), 395 orthodontists (specialists, MScs, and PhDs) responded. They answered questions regarding dental office and appointments during the pandemic, the type of urgency or emergency care provided, the type of appliance and urgencies, etc. The level of concern about the impact of the pandemic on patients' orthodontic treatments and the financial impact on the dental office was also evaluated. Descriptive statistics were performed with percentages, and responses were compared between specialists, MScs, and PhDs, using chi-square tests.
Results
Specialists were the majority of respondents. Most orthodontists were handling only emergencies or urgencies. The most frequent urgencies were bracket breakage, archwire breakage, and breakage of molar tubes and/or bands. Stainless steel fixed appliances were the most common type of appliance related to unscheduled appointments. The majority of patients got in touch with the orthodontist using the professional WhatsApp messenger (WhatsApp Inc, Menlo Park, Calif). Orthodontists were more concerned with the financial impact of the pandemic than with the orthodontic treatment itself.
Conclusions
Breakage of brackets, archwires, or tubes and/or bands were the most common causes of urgency and/or emergency appointments during the pandemic. The level of concern about the financial impact of the stay-at-home orders and the COVID-19 pandemic was significantly greater for specialists and MScs than for PhDs.
... The primary objective was to evaluate the predictability of orthodontic treatment with clear aligners monitored by DM and to assess if using the DM system can actually lead to better results and shorter treatment times by following patients closely and more accurately, and following the treatment plan as setup using the ClinCheck ® software. The results obtained in our study are in agreement with the literature [8,3] as they demonstrated excellent therapy control and a correspondence between the scans performed through the application and the office visits with intervals of 7-8 weeks. Furthermore, the study showed that after about 12 months, the scans obtained using the DM application showed excellent results for all three monitored malocclusions. ...
The primary objective of this study is to evaluate the Tpredictability of orthodontic treatment with clear aligners monitored by Dental Monitoring® (DM) and to assess if using the DM system can actually lead to better results and shorter treatment times. A secondary objective is to assess whether the DM system can be more effective in monitoring one type of malocclusion over another, namely: crowding, crossbite and diastema. A total of 55 patients treated consecutively with clear aligners were selected. All patients were asked to use the DM system with scheduled appointments at 7–8-week intervals. Our results show that photos and scans taken in the chair correspond accurately to the photos and scan taken by the patient using the DM system. Results also show that the different malocclusions did not show any difference in predictability when using the DM system. This study concluded that treatment time was indeed reduced in terms of total number of in-office appointments.
... Recently, research on systems of remote digital monitoring has substantially increased, also under the pressure of the COVID-19 pandemic (Sangalli, Fernandez-Vial, et al., 2022), thus permitting to highlight further advantages and limitations of these new advances. Specifically, in orthodontics their efficacy has been suggested as following: during the retention period, to monitor potential relapse in dental movements and in fitting of the removable retainers (Sangalli, Savoldi, et al., 2022); during the active therapy, to positively influence the oral hygiene of the patients , to replace in-person evaluation (Caruso et al., 2021;Sangalli, Fernandez-Vial et al., 2022), to reduce the number of inoffice visits and the treatment duration (Hansa et al., 2021;Hansa et al., 2018), to customize appointment frequency on individual basis (Hansa et al., 2021). In particular, in the present case, having a remote system for real-time monitoring allowed to minimize the psychological distress of the patient (Bianco et al., 2021), and permitted to early detect potential orthodontic emergencies, such as disengagement of the archwire from the bracket slot, loss of auxiliaries, detachment of brackets and orthodontic bands. ...
Moderate to severe cases of skeletal Class III malocclusion, where residual growth is no longer present and an orthodontic camouflage would not achieve satisfactory outcomes, are good candidates for a combined surgical-orthodontic approach. We present the case of a 34-year-old healthy male with skeletal Class III malocclusion, where aesthetics and masticatory function were further worsened by maxillary and mandibular transverse discrepancy, hyperdivergent pattern, moderate dental crowding, occlusal contacts present only on molars, negative overjet and overbite. The management of the case included a pre-surgical phase of surgically assisted rapid palatal expansion (SARPE) and an orthodontic treatment with fixed multi-bracket appliance, a surgical phase consisting in Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO), and a myofunctional physical therapy targeting orofacial muscles following the orthognathic surgery. The pre-surgical phase was additionally integrated with a system of remote digital monitoring, such as Dental Monitoring ® , to early detect any orthodontic emergency. As in-office visits were abruptly interrupted because of COVID-19 pandemic, the remote digital system also permitted to regularly monitor the patient at long-distance. In conclusion, a case of skeletal Class III malocclusion was successfully managed with a multidisciplinary approach which involved orthognathic surgery, orthodontic treatment, and myofunctional physical therapy. The additional integration of remote digital technologies, such as Dental Monitoring ® , may provide a continuity of care to orthodontic patients in times of COVID-19 pandemic, when the regularity of non-urgent chairside appointments might be disrupted.
... The orthodontist can decide to send a registration code to the patient's email address. This allows the patient to review the series of images and the overlay of the initial tooth position and the change in tooth position during treatment [6]. ...
Teleorthodontics refers to the use of Information Technology and Telecommunications to facilitate Orthodontic Consultation about the care to be rendered, the Practitioner, the Patient and Public Education as well as promoting Public Awareness. Despite skepticism, there are several advantages of including Teleorthodontics in the clinical Orthodontic Practice. In the present review, the new communication healthcare system and its applications in the field of Orthodontics that is destined to change the future of our clinical practice will be discussed. For this purpose, the point to point concept and the scope of Teleorthodontics has been provided. The information discussed in the present article is obtained from the most relevant studies evaluating the performance of Teleorthodontics and remote monitoring systems in clinical practice.
... Respondents reported that these visits most often occurred during time set aside during normal clinic business hours (85%). When asked about the average number of virtual visits/wk during the pandemic, the median response was 5 visits (IQR, [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Only 37% of respondents indicated that they provided a method for submitting intraoral photographs to receive a virtual smile assessment or consultation. ...
Introduction:
This study aimed to determine adaptations orthodontists made during the coronavirus disease 2019 pandemic to maintain safety and determine which adaptations will remain after the pandemic.
Methods:
An original 34-question survey was sent by mail to a randomized selection of practicing orthodontic specialists (n = 1000). Questions included the changes made during the pandemic in 4 categories (infection control, social distancing, appliance type, and teleorthodontics) and whether those changes will remain postpandemic.
Results:
The use of personal protective equipment increased during the pandemic, with a significant decrease anticipated after the pandemic. The most common aerosol modification during the pandemic and predicted after the pandemic was using an assistant with high-volume suction (61% and 49%, respectively; P = 0.0013). Ninety-six percent of orthodontists changed their waiting room protocol during the pandemic, but only 23% plan to continue that practice (P <0.0001). Forty-two percent of orthodontists increased clear aligners during the pandemic in response to patient demand (91%). The use of teleorthodontics increased from 8% to 68% during the pandemic and is expected to decrease significantly postpandemic. Virtual appointments are anticipated to be used for screening and consultations of new patients and monitoring active patients in clear aligners but not fixed appliances.
Conclusions:
The specialty recommended patient safety modifications during the coronavirus disease 2019 pandemic. Postpandemic, enhanced personal protective equipment is expected to decrease, and high-volume suction will likely be continued for aerosol-producing procedures. Teleorthodontics will likely remain in limited use.
... Tele-orthodontics is a broad term that encompasses remote provision of orthodontic care, advice, or treatment via information technology [8]. In the early to mid-2000s, promising results were achieved by orthodontists supervising general dental practitioners in real time to provide orthodontic services to patients with limited access to orthodontic care [9,10]. ...
... Pasien yang benar dalam keadaan darurat, seperti pembengkakan, nyeri tidak terkontrol, pendarahan, dan trauma pada gigi atau tulang serta terlepas dan patahnya kawat atau bracket yang dapat mengiritasi mukosa rongga mulut. [25][26][27][28] ...
Background: In 2020, WHO declared the name of the Coronavirus disease 2019 (Covid-19). In the middle of the pandemic, orthodontists have limited their treatment. The challenges of the orthodontic profession in performing treatment become more difficult due to many factors, such as high saliva concentrations. Objective: To find out how to prevent cross-infection of Covid-19 in performing orthodontic treatment during the pandemic. Methods: By using a literature review, information that is relevant to the topic of the study is collected and then synthesized in an article. Results: It was found that there were similarities in the dis-cussion regarding the difficulty of consulting and taking active and inactive orthodontic treatment actions during the Covid-19 pandemic. Conclusion: In orthodontic treatment during this pandemic, dentists and clinical health staff must triage patients be-fore visiting the clinic and must carry out infection control management at the clinic, both orthodontic treatment procedures and other pressure.
... This digital technology software allows orthodontists to monitor patients remotely (Kravitz et al. 2016). The DM app utilizes a patented AI ML algorithm to calculate 3D tooth movements from intraoral photos and videos that patients capture using their smartphone cameras (Hansa et al. 2018). This app comprises three interconnected platforms: a smartphone application for patients, a patented tooth movement AI tracking algorithm, and an online Doctor Dashboard where orthodontists can view patient treatment progress and post-treatment changes. ...
Deep learning (DL) is the most recent subset of machine learning with networks capable of learning unsupervised from unstructured data. This chapter provides a comprehensive review of the current application of artificial intelligence in treating patients with clefts and craniofacial anomalies (CFAs). AI can be used in the detection and classification of CFAs, identifying facial phenotypes of genetic disorders with DL, analysis of CFAs, and prediction of genetic risk of non‐syndromic oral clefts. Benign metopic ridge (BMR) is a normal variant of metopic suture, which is present in 10‐25% of infants. Patients with BMR are recommended for conservative non‐surgical treatment, while those with true metopic craniosynostosis require surgical correction. Cephalometric analysis is typically time‐consuming and needs to be performed by a well‐trained expert. Cone‐beam computed tomography is rapidly supplanting 2D cephalometric analysis in craniofacial care due to its value in 3D diagnosis and virtual treatment planning.
... 15 However, almost all the DIY companies focus majorly on the alignment of the teeth without much focus on esthetic harmony and functional occlusion. 16 Thus, resulting unstable occlusion could result in many stomatognathic complications such as temporomandibular joint problems, improper mastication, relapse, and so on. Furthermore, in many circumstances, an accurate diagnosis of a certain situation is not possible without clinical examination, radiographs, and study models. ...
Objective
To have an understanding of the fact how the popularity of “do it yourself” (DIY) videos available on YouTube correlate with authorship, content, quality, reliability, and how they appeal to and influence the customers.
Materials and Methods
A new YouTube account was created, this was followed by a determination of the most commonly used keywords regarding DIY aligners by using “Google Trends.” The keywords were used to search the YouTube website. A total of 112 videos were assessed for various parameters, such as completeness of the content, reliability using a modified version of the DISCERN tool, and quality using a Global Quality Score (GQS). Out of 112 videos, 26 were rejected based on their relevance, duplication, videos without audio, and video language. Pearson’s correlation coefficient was used to study the relationship between the variables, authorship, popularity, and recommendations.
Results
The majority of the videos were uploaded by the laypeople (43%), followed by DIY aligner companies (38%), and dentists and orthodontists (16%). The content for most of the videos was poor (82%), with DISCERN reliability score of zero (65%), and GQS of 1 and 2 (poor to generally poor quality). The view of uploaded videos, view rate, and likes was in proportion to the quality of the videos, their popularity, and reliability. Further authors with a financial interest and poor quality, content, and less reliability of the videos usually recommended the DIY aligners. The reduced cost was one of the important factors for the customers to consider DIY aligner treatment.
Conclusion
YouTube videos on DIY aligners should not be considered a reliable source for the public in general who are looking for orthodontic treatment for correction of their dentofacial irregularities. The dental professional bodies and orthodontists should use social media platforms (YouTube) to increase awareness about the DIY aligners among the public.
... [9][10][11] Oppositely, enablers can improve the degree of compliance through effective communication, increased monitoring, internal motivation, as well as improved quality of life. [12][13][14] The ability for patients to view their treatment plan on the ClinCheck software provides effective communication of the treatment plan. The discrete nature of the precision wings may also provide an advantage in patient comfort and aesthetics, compared to traditional appliances. ...
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
... DM also reduces the first refinement time by 1.7 months when DM refinements are performed earlier (due to the more frequent and proactive monitoring). The treatment's efficacy may also be improved by this system, which offers the possibility of identifying mistakes and problems at an early stage, such as debonded brackets, non-tracking aligners, and broken ligatures [25,65,66]. ...
This review aims to analyze the multiple factors affecting patients’ level of compliance (how much they wear removable devices/clear aligners) during orthodontic treatments and to investigate the available methods and devices to monitor the appliance wearing time and to improve it. A literature search was conducted on electronic databases (Pubmed, Scopus, and Google Scholar). The results of the present study suggest that compliance indicators may misestimate the intraoral wearing time. Compliance is affected by patient-related factors (age, personality traits, the importance of personal appearance, self-perception of malocclusion), appliance-related factors (visibility, pain/discomfort), and clinician-related factors (trust, clear and complete communication, motivation). The motivation of pre-pubertal patients is mostly external, while adolescents/young adults have intrinsic motivation for orthodontic treatment. Patients’ self-reports tend to overestimate the appliance wearing time. Even if there is a lack of evidence, teledentistry might improve patients’ awareness of being monitored, thus increasing the time for which orthodontic devices are worn. Compliance is a key factor for clear aligner treatments, but high-quality studies focusing on this aspect are missing. Further studies should focus on how to handle the lack of cooperation and how to increase compliance in order to maximize the treatment’s results.
... [9][10][11] Oppositely, enablers can improve the degree of compliance through effective communication, increased monitoring, internal motivation, as well as improved quality of life. [12][13][14] The ability for patients to view their treatment plan on the ClinCheck software provides effective communication of the treatment plan. The discrete nature of the precision wings may also provide an advantage in patient comfort and aesthetics, compared to traditional appliances. ...
Objective
To examine the skeletal, dental, and soft-tissue cephalometric effects of class II correction using Invisalign’s mandibular advancement feature in growing patients.
Materials and Methods
A retrospective cohort clinical study was performed on cases that were started between 2017 and 2019. A total of 32 patients (13 females, 19 males), with an average age of 13 years old (9.9-14.8 years) had undergone Invisalign treatment (Align Technology, Inc., San Jose, CA) wherein the mandibular advancement phase was completed were included. Photos, digital study models, and cephalograms were taken once during the patients’ initial visit and again upon completing the mandibular advancement phase of treatment. The number of aligners worn and the time of treatment in months was recorded for each subject. Cephalometric analysis was performed and overjet and overbite were measured. Statistical analysis was performed using SPSS statistical software (version 25; SPSS, Chicago, Ill) and the level of significance was set at P <0.05. Descriptive statistics were performed to generate means and differences for each cephalometric measurement as well as patient data including age, treatment time, and aligner number. Differences between measurements from patients before treatment (T1) and after treatment (T2) with the mandibular advancement feature were evaluated using a paired t -test.
Results
All 32 patients had multiple jumps staged for the precision wings, i.e., incremental advancement. The average length of treatment for the MA phase was 9.2 months (7.5-13.8 months) and the average number of aligners used during this time was 37 (30-55). Statistically significant differences between T1 and T2, in favor of class II correction, were observed in the ANB angle, WITS appraisal, facial convexity, and mandibular length. The nasolabial angle, overjet, and overbite also showed statistically significant changes between T1 and T2.
Conclusion
Invisalign aligners with the mandibular advancement feature took approximately 9 months for 1.5 mm of overjet correction. The lower incisor angulation was maintained during class II correction. The minimal skeletal changes are in favor of class II correction.
... b Wearable devices to monitor pH and temperature of saliva 38 . c Judging the movement of teeth based on photos taken by smartphones 95 . d Wearable patch attached onto teeth to detect oral microbiomes 37 . ...
Physiological monitoring can provide detailed information about health conditions, and therefore presents great potentials for personalized healthcare. Flexible miniaturized sensors (FMS) for physiological monitoring have garnered significant attention because of their wide applications in collecting health-related information, evaluating and managing the state of human wellness in long term. In this review, we focus on the time scale of human physiological monitoring, the needs and advances in miniaturized technologies for long-term monitoring in typical applications. We also discuss the rational sample sources of FMS to select proper strategies for specific monitoring cases. Further, existing challenges and promising prospects are also presented.
... Remote monitoring systems are part of Artificial Intel-ligence Driven Remote Monitoring. 19,20 In the past few years, the market has assisted an increased availability of orthodontic apps to enhance long-distance monitoring and compliance, 21 and a recent study confirmed the positive attitude of patients towards this new digital technology. 22 In orthodontics, it can be applied for monitoring of several treatment aspects, 23 including patients' oral hygiene during the therapy, 16,24,25 treatment with clear aligners, 26,27 rapid palatal expansion, 15,28,29 adherence to the use of removable retainers, 8 active working time of self-ligating straight-wire appliances, 30 and clinical follow-up of corticotomy-accelerated orthodontic therapies. ...
Objective:
To evaluate if a remote digital monitoring system added at the end of orthodontic treatment could positively influence the retention phase by reducing the occurrence of misfit of removable appliances, number of emergency appointments (EA), and orthodontic relapse.
Methods:
Twenty-seven patients who completed active orthodontic treatment were divided into the study and control groups. In addition to the standard chairside follow-up appointments at month 1 (T1), month 3 (T2), month 6 (T3), the study group patients were monitored using Dental Monitoring® with monthly intra-oral scans. Occurrence of misfit of removable retainers, number of EAs, and intercanine width change were recorded for both groups. Differences in EAs and retainer fit were assessed using the chi-square test. Intra-group and inter-group differences in the intercanine width were assessed with Friedman test and Mann-Whitney U test, respectively (α = 0.05).
Results:
The study group showed a significantly lower occurrence of misfit of removable retainers (p = 0.027) compared to the control group. No significant inter- and intra-group difference was found in the EAs and intercanine width change at each time-point.
Conclusions:
Integrating remote monitoring systems, such as Dental Monitoring®, to the retention phase of the orthodontic treatment may lower the occurrence of misfit of removable retainers. However, a small sample size and a short observation period limit the strength of this evidence. These preliminary results tentatively suggest that remote monitoring technologies may be beneficial, especially during the COVID-19 pandemic, when the regularity of in-office visits might be disrupted.
... 3 This has led to the possibility of remote monitoring and scheduling in-office appointments personalized for treatment progression. 4 The development of CAT, whose main advantages are fewer appointments and reduced chair time, has been popularized worldwide. 5 In 1997, Align Technology was founded and began developing their version of CAT. 5 Originally, their system was marketed solely to orthodontists. ...
Objectives:
To evaluate orthodontists' perceived impacts on their practices as a result of general practitioners (GPs) and direct-to-consumer (DTC) orthodontic care providers and the adaptational changes implemented in the past 10 years.
Materials and methods:
An electronic survey was administered to 270 orthodontists in Canada and the United States to determine demographic background, perception of perceived impact, and specific changes implemented to improve practice competitiveness.
Results:
More experienced orthodontists (P = .0001) and males (P = .027) were more likely to indicate a perceived impact from GP orthodontics. American orthodontists were significantly more likely than Canadian orthodontists to perceive an impact from DTC providers (P = .017). There was a positive association with orthodontists' years of experience and having implemented adaptational changes to their practice for a period greater than 10 years across multiple categories. Female orthodontists were more likely to have implemented adaptational changes for a period of less than 10 years across multiple categories.
Conclusions:
The perceived impact of GPs providing orthodontic care was greater than that of DTC providers. American orthodontists were significantly more likely to perceive an impact from DTC providers. Orthodontists have experienced a reduction in referrals from GPs and an increase in referred case difficulty. Less experienced and female orthodontists have made the most adaptive changes to their practices in the past 10 years.
... Hansa et al. [8] found a significant reduction of about 23% of the number of appointments over the treatment duration carried out with clear aligners in the DM group compared with the unmonitored group. ese findings are of great clinical relevance since they support the assumption that remote monitoring could decrease chairside time and relative costs to both orthodontic care providers and patients [26,27]. ese data were also confirmed by previous preliminary evidence of the same study group [28]. ...
Teleorthodontics represents the orthodontic care system involving remote management of orthodontic treatment. Despite skepticism, there are several advantages of including teleorthodontics in the clinical orthodontic practice. In the present review, we discuss the lights and shadows of this new communication healthcare system and its applications in the field of orthodontics that is destined to change the future of our clinical practice. For this purpose, we have provided a point-to-point analysis based on data from the most valuable scientific evidence on this topic. e information and data discussed in the present paper were obtained from the most relevant studies evaluating the performance of teleorthodontics and remote monitoring systems in clinical practice.
... For example, customers may not be fully aware that a six-monthlong treatment with DIY aligners will usually improve only the alignment of the anterior teeth. 20 Cliniciandirected orthodontic treatment aims to align teeth as well as achieve the 'six keys' to normal occlusion. 21 The alignment of the patient's teeth without occlusal correction may cause problems with oral function. ...
Objective: The present study aimed to determine how the popularity of ‘Do It Yourself’ (DIY) aligner videos available on YouTube relates to authorship, video content, quality and reliability, and to determine why DIY aligners appeal to consumers.
Methods: The Google Trends website was interrogated to identify the most frequently used search terms regarding DIY aligners which were subsequently applied to a search of the YouTube website. One hundred twenty-three videos were assessed for completeness of content, reliability (using a modified version of the DISCERN tool) and quality using the Global Quality Score (GQS). The relationship between the variables and authorship, popularity, financial interest, and recommendations were assessed using Pearson Correlation Coefficients.
Results: Laypeople produced the majority of the videos (73%). Dentists/Orthodontists uploaded only 4% of the videos, and dental professional bodies uploaded none. Most videos (86%) were content poor, unreliable (average DISCERN score of 1) and of low quality (average GQS of 2). The more popular, reliable and superior the quality of the video, the greater the number of views, likes and viewing rate ( p < 0.05). Conversely, authors with a financial interest and lower quality and less reliable videos were more likely to recommend DIY aligners. Consumers sought DIY aligner treatment due to a reduced cost.
Conclusions: YouTube should not be considered as a viable nor reliable source of DIY aligner information for patients or the public. Dentists/Orthodontists should be encouraged to publish comprehensive and more informative YouTube content related to DIY aligners.
... With teledentistry and telemedicine proving to be particularly useful during the pandemic, the World Health Organization (WHO) must set down guidelines that regional regulatory authorities can adopt [45,46]. Establishing guidelines would aid in solving legal, scientific, and ethical issues occurring with the implementation of transregional programs [47][48][49]. ...
In the Southeast Asian region, various policies have been advocated by health regulatory bodies that entail protective measures such as face masks, gloves, maintaining distance in public areas, and more. These protective measures are aimed at helping reverse the growth rate of the coronavirus. Dentists in this region have incorporated several changes to their practices to help minimize risks of person-to-person transmission inside dental offices. This narrative review aimed to provide an in-depth overview of the current situation in the Southeast Asian region regarding the use of teledentistry during the pandemic. Teledentistry involves the transfer of patient information across remote distances for online consultation and treatment planning. A few years back, it used to be a lesser-known entity but has seen an exponential rise in its incorporation into dental practices all around the Association of Southeast Nations (ASEAN) region. Many clinics in the Southeast Asian region have started using online consultations to ensure that patients can be diagnosed or followed up during their treatment. Teledentistry is the clear answer in the coming months as it will help reduce the risk of virus transmission and help patients get access to oral healthcare and dentists to see their patients. This article reviews the current pandemic situation in the ASEAN region, the recent evidence, and the scope of teledentistry. It also provides recommendations for the future and sheds light on the different types of teledentistry and how it can be incorporated into practices by regulatory authorities in this region.
... This relates to capacity issues, meaning that orthodontists are typically unable to review retention indefinitely. 9 While the possibility of remote monitoring of orthodontic retention is becoming more established, 13,14 the expectation may also be for the patient to monitor their own tooth alignment and retainers. This prospect is perhaps somewhat daunting, with a lack of follow-up appointments linked to independent decisions to continue or cease retainer wear. ...
Introduction Long-term orthodontic retention using removable or fixed retainers is needed to maintain the outcome of orthodontic treatment. The aim of this article is to describe how long-term retention is managed and to report on a survey of general dental practitioners (GDPs) as to how this management currently operates in the UK.
Materials and methods GDPs were invited to complete a short online survey on orthodontic retention using an open notice posted in the British Dental Journal and a direct email to the members of a local dental clinical society.
Results Fifty-six GDPs completed the online survey. Overall, the findings highlighted poor levels of communication between orthodontists and GDPs with respect to the latter assuming responsibility for the management of long-term retention.
Conclusion The management of long-term retention could be improved by more effective communication between the orthodontist and GDP. One solution might be a retention management pro forma. GDPs are in some instances willing to undertake more of the management of retention following further training and possible remuneration.
... Previous literature suggested that tele-orthodontics reduces the time spent in the dental office [21]. Moreover, many of the orthodontics emergencies could have been solved by tele-orthodontics without urgent need of a dental chair visit [33]. The literature demonstrated that aligners-for example, Invisalign-needed only a follow-up to continue treatment, which can be provided via tele-orthodontics [21]. ...
Background:
The COVID-19 pandemic outbreak may have a large impact on orthodontic treatment. Regular orthodontic visits were strongly and widely interrupted by the unprecedented epidemiological threat.
Methods:
The data regarding orthodontic queries were investigated in a real-time surveillance using Google Trends. Search terms "braces", "invisalign", "get braces", "get braces off", "braces pain" and the phrase "social distancing" were analyzed regarding the year preceding the pandemic outbreak and the time of the pandemic. Moreover, the five-year trend for queries "braces" vs. "invisalign", as an example of different types of orthodontic appliances, was compared.
Results:
There was a significant decrease in orthodontics phrase queries in the spring of 2020, connected with the worldwide restrictions and lockdowns announced all over the world. There was a lower interest in the "braces pain" query during the first lockdown in 2020. The number of searches for "invisalign" increased steadily over time, while the number of searches for "braces" was relatively stable across the investigated time period.
Conclusions:
The course of the COVID-19 pandemic has had a large impact on the orthodontic-related search queries. Orthodontists must be better-prepared for any sudden changes in the possible future in the epidemiological situation that may change accessibility to dental offices.
... It is noteworthy that there are a lot of patient-associated problems that cannot be sorted through remote consultations. While tele-orthodontics may be useful in getting initial opinions, an in-office visit is recommended for obtaining comprehensive diagnostic records [3]. Since orthodontic treatment is a continuous process, it is essential for an orthodontist to establish a rapport with the patient to ensure cooperation during treatment. ...
The article's abstract is not available.
... No standardization of records sent by patients Possible breach in security and ethical issues Lag in data transfer in real time which might lead to patient dissatisfaction Workflow integration requires expertise Use of ICT in Orthodontics has been explored in following domains, given in Table 3 [5][6][7][8][9][10]. ...
Orthodontic science has progressed tremendously in the last two decades, from traditional stainless wires and brackets to sophisticated contemporary materials, types of brackets and bonding agents, anchorage devices and the use of nanotechnology. The development has extended to all domains of diagnosis, treatment planning, treatment alternatives, storage of data, patient education and marketing. This chapter comprehensively lists all spheres of advancements, highlighting the advantages and limitations of each of the enumerated processes. Digitization in orthodontics has completely revolutionized diagnosis, employing three-dimensional (3D) analysis by intraoral scans, 3D-Cone Beam Computed Tomography (3D-CBCT) radiographs and stereophotogrammetry, for greater accuracy and possibility of virtual setting. In addition, aligner technology has also seen a boom using this virtual data for computer aided design(CAD) and creation of appliances by 3D printing. Varied softwares have found their way into orthodontic office for analysis, superimpositions and predictions, thus allowing the patients to make informed decisions. Few softwares also allow remote patient monitoring, tele-orthodontics, patient education and reminder applications. Social media has become a powerful tool for product awareness, discussions with patients, orthodontic teaching, though the accuracy of information is questionable. Acceleration of orthodontic treatment has been targeted with various surgical (micro-osteoperforation, corticotomy, Wilckodontics etc.), non-surgical (vibration, lasers etc.) and biological (prostaglandins etc.) agents. This chapter also touches upon upcoming areas like machine learning, artificial intelligence and big data in orthodontics which can aid in evidence-based practice from large clinical repositories in cost effective ways. Current COVID-19 times brings forth the importance of virtual patient data and minimal patient contact, thus emphasizing the role of modified orthodontic triage, a significant mention of which has been made in the current chapter.
... It is noteworthy that there are a lot of patient-associated problems that cannot be sorted through remote consultations. While tele-orthodontics may be useful in getting initial opinions, an in-office visit is recommended for obtaining comprehensive diagnostic records [3]. Since orthodontic treatment is a continuous process, it is essential for an orthodontist to establish a rapport with the patient to ensure cooperation during treatment. ...
Dentistry and orthodontics have been shown to be highly risky in terms of cross-infection, making tele-dentistry a practical tool to help reduce viral dissemination by eliminating direct person-to-person contact. Tele-orthodontics allows both patient and clinician to save time, money and ensure that the patients’ fears are alleviated. It is not only fundamental for the continuation of treatment but also from an emotional/psychological view, it helps reassure patients of their treatment progress. However, the reliability of records obtained from patients must be considered. For this purpose, benchmarks should be established for minimum desired quality and quantity of records. Digital orthodontics is a new area which requires basic standards to ensure that the quality of treatment is not compromised.
... In the near future, personalized aligner change protocols may be used to enhance aligner efficiency. 26,27 Limitations A limitation of 3D superimposition was the lack of stable anatomic structures on the predicted models, as stereolithography files exported from ClinCheck contained only the clinical crowns and virtual gingiva. In addition, the ClinCheck plan was simply a visual representation of force systems, rather than a true prediction of final tooth position; hence, the predicted tooth position may not have actually been the one desired. ...
Objectives
To compare the efficacy of orthodontic tooth movement with three aligner wear protocols: 7 day, 10 day, and 14 day.
Materials and Methods
Eighty patients were randomly allocated into three groups: group A (7-day changes), group B (10-day changes), and group C (14-day changes). The posttreatment scans were compared with the final virtual treatment simulations through digital superimposition. The differences between predicted and actual achieved treatment outcomes were computed in six angular and six linear dimensions. Differences >0.5 mm for linear measurements and >2° for angular measurements were considered clinically relevant.
Results
Within groups, and irrespective of wear protocol, all linear discrepancies in both jaws were deemed clinically insignificant (<0.5 mm) while nearly all angular discrepancies were considered clinically significant (>2.0°). When the three groups were compared, group C (14-day changes) showed significantly greater accuracy in the posterior segment for maxillary intrusion, distal-crown tip and buccal-crown torque, and mandibular intrusion and extrusion. The mean treatment duration in the 7-day aligner change group was nearly half that of the 14-day aligner change group (5 months vs 9 months).
Conclusions
Fourteen-day changes were statistically significantly more accurate in some posterior movements. However, this difference in accuracy did not exceed the threshold for clinical significance (>0.5 mm/>2.0°). Achieving a clinically similar accuracy between the 7-day protocol and 14-day protocol in half the treatment time suggests a 7-day protocol as an acceptable treatment protocol. Clinicians may consider slowing down to a 14-day protocol if challenging posterior movements are desired.
... It is common that a series of aligners are provided to the patient to last for a defined period before returning to the practice for evaluation and additional aligners. Some orthodontists deliver all the aligners up-front, and then they may follow treatment progress using virtual visits online or with a monitoring system [8,25]. Even though some aligner brands may prove to be very expensive, a low-cost alternative is to use inhouse aligners that may prove more economical over the long run, as well as ensure that the patients' treatment go on as planned with predictable tooth movements. ...
Fixed orthodontic treatment has been compromised at many levels during the pandemic period, asclinics underwent a prolonged lockdown and patients could not be treated regularly. With the end ofthe pandemic nowhere in sight, may be it is time to put newer tools, such as clear aligner therapy,for better use. Fixed orthodontic appliances by nature are not always self-limiting, which, if leftunmonitored over a long period may cause undesirable side effects, pain, and discomfort. The undesired tooth movements that may occur with arch wire-guided mechanics in addition to problems with cutwires or removed brackets may be minimized with the use of aligners. While the benefits of using aligners are for all to see, they do require extensive planning and careful evaluation of the progress. This article reviews the advantages of using aligners during the pandemic period and how it can be beneficial in helping orthodontists resume their practice.
... 1 Moreover, teleorthodontics reduces the need for in-office patient visits, which is in contrast to traditional orthodontic treatment. [13][14][15] Based upon these findings, it is evident that teleorthodontics supports orthodontic diagnosis and treatment. Despite such benefits, factors such as irregular in-office visits may jeopardize patient compliance in terms of oral hygiene maintenance and adherence to the planned treatment protocol, 16,17 which may, in turn, compromise the outcome of orthodontic treatment. ...
Purpose: The aim was to evaluate the scope and potential ethical concerns related to the use of teledentistry in clinical Orthodontics.
Methods: Indexed databases were searched up to and including October 2020. The eligibility criteria were as follows: (a) original clinical studies; and (b) case reports/series. Historic reviews, commentaries, experimental studies, and letters to the Editor, were excluded. The pattern of the present review was customized to summarize the relevant information.
Results: A total of four clinical studies (out of 1016) were included in the present evidence-based review. Three studies reported that teledentistry is useful in clinical Orthodontics. In one study, a clear conclusion could not be derived regarding the benefits of teledentistry in clinical Orthodontics. Two out of four studies did not obtain prior approval from an Institutional Review Board or Ethical Committee. Three studies did not report any measures that were undertaken to safeguard the electronic transfer of patient-related health information.
Conclusions: Teleorthodontics facilitates treatment planning/monitoring by sharing orthodonticsbased patient records among oral health care providers; however, the importance of direct patientsupervision and routine follow-ups during orthodontic therapy cannot be overlooked. Furtherstudies are needed to establish ethical guidelines and a standard of care in this emerging field.
Remote consultations in orthodontics were quickly thrust to the forefront of the orthodontic profession during the COVID-19 pandemic of 2020. With the UK public now accepting telephone consultations and various video applications as a convenient and secure method of communication, it seems likely that, even after the ramifications of the COVID-19 pandemic have dissipated, increased use of remote consultations will continue to be seen as desirable. It is therefore important that orthodontists, and any other orthodontic staff who have been delegated the task of being involved in teleorthodontics ensure they are aware of the limitations as well as the benefits of teleorthodontics. They should also be able to demonstrate competence in how to effectively and appropriately carry out teleorthodontic appointments remotely with patients.
CPD/Clinical Relevance: It is likely that patient expectations surrounding traditional face-to-face consultations will change as a result of the COVID-19 pandemic and the opportunity to investigate and explore new ways of working should be embraced. Working through the considerations that must be taken at each stage of the remote consultation as well as the use of appropriate checklists will ensure that the risk of human error is reduced, while undertaking remote consultations in orthodontics.
Introduction
Teledentistry in orthodontics is growing, yet patient preferences for its use is unknown. This study aimed to determine the perceived value of doctor-to-patient face-to-face interaction, convenience, and attitudes toward specific uses of teledentistry among orthodontic patients.
Methods
Private practice orthodontists emailed an electronic survey to active patients. Patients aged ≥18 years completed the survey regarding their treatment. Parents of patients aged <18 years completed a separate survey regarding their child’s treatment. Responses were compared on the basis of patient characteristics (adult vs child, braces vs clear aligners, etc).
Results
Three hundred and eighty-eight respondents from 8 orthodontic practices participated in the survey. Eighty-five percent of parents considered face-to-face interaction important, and 85% said that their child’s treatment fit conveniently into their schedule. Adult responses were 86% and 89%, respectively. Adult preference for face-to-face was significantly higher than parents of adolescent patients (83% vs 78%; P = 0.038). Adults treated with clear aligners were less likely to strongly agree that their treatment fitted conveniently in their schedule (51% vs 76% in braces; P = 0.0490) and were more likely to be interested in using teledentistry (27% vs 18% in braces; P = 0.0429).
Conclusions
Most orthodontic patients prefer to be seen face-to-face. This is due to the high value placed on face-to-face interaction with the orthodontist. Most patients do not consider their treatment inconvenient. Patients prefer that teledentistry be used to enhance communication as opposed to replacing face-to-face interaction. Implementing teledentistry in orthodontics should be applied on a patient-to-patient basis with continued emphasis on the doctor-patient relationship.
The objective of this study was to assess the feasibility and acceptability of conducting remote new patient consultations using teleorthodontics. Part 1 of the study used a five-point Likert-scale patient questionnaire and Part 2 comprised an orthodontist service evaluation assessing: (1) ease of use; (2) effectiveness; (3) reliability; (4) patient satisfaction; and (5) orthodontist satisfaction and outcome. The results for Part 1 showed that overall, 99% of patients reported that the system was easy to use, while 98% felt that it met their needs and 91% would choose to consult with a healthcare professional in a remote consultation in the future. For Part 2, 87% of orthodontists reported the remote consultation system worked well. Orthodontists were unable to identify the IOTN in 11% of cases and 11% required a further face-to-face appointment for imaging or clinical examination. In conclusion, teleorthodontics has the potential to augment traditional clinical services, such as during the COVID-19 pandemic, and beyond. An overwhelmingly positive response towards teleorthodontics was obtained from patient and specialist orthodontist stakeholders.
CPD/Clinical Relevance: The teleorthodontic system demonstrates improved patient and orthodontist acceptance and feasibility and can deliver good outcomes.
Dentistry is one of the fields that are hugely affected by the COVID-19 pandemic due to high concentrations of contaminated aerosols which can be transmitted while undergoing dental procedures and can potentially lead to the nosocomial spread of the COVID-19 virus. Teledentistry, a subunit of telehealth, is an alternative that is widely chosen to diminish in-clinic appointments and to support social distancing. The four main methods of teledentistry are live or synchronous video, store-and-forward (asynchronous), remote patient monitoring (RPM), and mobile health (mHealth). Teledentistry can be applied to all specialities including oral medicine, oral and maxillofacial surgery, endodontics, orthodontics, prosthodontics, periodontics, pediatric and preventive dentistry with high accuracy and reliability. The process of teledentistry consists of subunits including teleconsultation, telediagnosis, teletriage, and telemonitoring. Focusing on its advantages, regarding the affordability and convenience of teledentistry, it originated a paradigm shift for the prevention and promotion of oral health. COVID-19 patients can still receive dental care with the use of teledentistry. Moreover, it aids patients from rural areas where access to dental specialities is limited. However, solutions to address concerns about the image quality, digital literacy of both healthcare providers and patients, insufficient financial reimbursement of dentists, security and technical issues are required to enhance the effectiveness of teledentistry. Hopefully, this review paper can be helpful for giving information regarding teledentistry.
Technology plays an increasingly important role in the day-to-day practice of orthodontics. With the exponential development of Artificial Intelligence and communication technologies, there is an increased viability and potential for the remote monitoring of orthodontic treatment which has the potential to yield tremendous benefits to both clinicians and patients. Scholarly scientific validation and investigation of these technologies are yet in infancy, for monitoring to become mainstream and obtain greater acceptance. This case series aims to review the clinical applicability and rationale of orthodontic remote monitoring.
Mobile applications (apps) play an increasingly important role in day to day life. With the number of orthodontic-related apps continuing to increase, and the rapid development of artificial intelligence, the potential to yield tremendous benefits to both clinicians and patients is apparent. However, if orthodontic apps are to become mainstream and obtain greater acceptance, scientific validation and investigation of these apps are to be undertaken. This scoping review aimed to determine the scope and extent of the published literature on mobile apps in orthodontics, as well as identify the types of studies published, and summarize the outcomes studied-thus also giving direction for future research in a rapidly evolving subject area. Ó 2020 World Federation of Orthodontists.
The past decade (2009-19) has seen orthodontics incorporate many new infusions into its fold. This scoping review analyzes published orthodontic liter-aure in five different domains:(1) Recent advancements in orthodontic 3D applications including 3D printing, diagnosis and management. (2) Recent advancements in orthodontic biomaterials, nanotechnology, biomimetics, battery-driven devices. (3) Recent advancements in orthodontic patient education , orthodontic training, and orthodontics practice management. (4) Recent advancements in orthodontic E-health protocols, tele-orthodontics, teleconsultations etc. and (5) Recent advancements in orthodontic marketing and social media influences. A total of 1245 records were searched,of which 65 potentially relevant articles were retrieved in full. 42 studies met the selection criteria following screening and were included in the scoping review. The review found studies pertaining to morphological features or surface characteristics with respect to 3D applications (3D printing, diagnosis and management)as the most represented outcome assessment (49%). Orthodontic Marketing & Influence of Social Media (27%) and Biomaterials, Nano-Technology,Biomimetics and battery Driven devices have also been considerably reported (20%) in the past decade. More scientific data needs to be gathered in the field of Patient education, E-health, tele-orthodontics, and protection of patient confidentiality. The authors present COS (Core Outcome Sets)that could be a road map for evaluating currently employed developments as well as testing new ones in future. (Semin Orthod 2019; 25:339-355)
The article explores the current orthodontic landscape with respect to the challenges that affect the pursuit of excellence in the specialty. These challenges include marketing by manufacturing companies, financial pressures, marketplace competition, attaining practice efficiency, new product introduction with limited supporting evidence, attributing greater importance to patient experience than the best approach to treatment, and lack of public education regarding their best interests. Home or DIY treatment, bypassing office visits and the practitioner, have also emerged as a concerning trend with the public not clearly understanding the detrimental consequences that may ensue. An over reliance on technology may override individualized treatment and further compromise treatment results.
The usage of the portable electronic devices such as the smartphones and handheld tablets has increased over the years, and this is true in the health-care industry also. This is because of the development of various patient management softwares. The use of apps to manage, educate, and inform patient is not uncommon among orthodontists nowadays. The aim of this article was to review the various apps available on the Google Play Store and iOS Apple Store for orthodontists and patients. Four smartphones using orthodontically relevant keywords such as orthodontics, orthodontists, and braces were searched and reviewed in detail. Out of the 354 orthodontically relevant apps available in both Android and Apple operating systems, the apps could be categorized as orthodontist-related apps or patient-related apps. Under these categories they could be further classified as practice managements apps, patient education apps, model analysis apps, tooth material calculators, patient reminder apps, etc.
The purpose of this pilot study was to assess whether orthodontic treatment planning is reproducible when carried out using digital records compared with clinical examinations or using standard records. The study also assessed patients' opinion of face-to-face consultations and potential use of teleorthodontics. The study was designed as a prospective observational cross-sectional pilot study and carried out in a UK dental teaching hospital involving 27 subjects. Four consultant Orthodontists carried out treatment planning, firstly following a clinical examination, then using standard records, and then using digital records. Each subject completed a questionnaire. Cohen's kappa coefficient and Fleiss' kappa coefficient were used to assess intra-observer reproducibility and inter-observer reproducibility of treatment planning decisions, respectively. A change in the diagnostic information format affected treatment planning reproducibility for half of the observers. Inter-observer reproducibility was greater when using hard copy records in comparison to digital records. No subjects were unsatisfied with their face-to-face consultation.
Objective:
To assess the scientific evidence related to the efficacy of clear aligner treatment (CAT) in controlling orthodontic tooth movement.
Materials and methods:
PubMed, PMC, NLM, Embase, Cochrane Central Register of Controlled Clinical Trials, Web of Knowledge, Scopus, Google Scholar, and LILACs were searched from January 2000 to June 2014 to identify all peer-reviewed articles potentially relevant to the review. Methodological shortcomings were highlighted and the quality of the studies was ranked using the Cochrane Tool for Risk of Bias Assessment.
Results:
Eleven relevant articles were selected (two Randomized Clinical Trials (RCT), five prospective non-randomized, four retrospective non-randomized), and the risk of bias was moderate for six studies and unclear for the others. The amount of mean intrusion reported was 0.72 mm. Extrusion was the most difficult movement to control (30% of accuracy), followed by rotation. Upper molar distalization revealed the highest predictability (88%) when a bodily movement of at least 1.5 mm was prescribed. A decrease of the Little's Index (mandibular arch: 5 mm; maxillary arch: 4 mm) was observed in aligning arches.
Conclusions:
CAT aligns and levels the arches; it is effective in controlling anterior intrusion but not anterior extrusion; it is effective in controlling posterior buccolingual inclination but not anterior buccolingual inclination; it is effective in controlling upper molar bodily movements of about 1.5 mm; and it is not effective in controlling rotation of rounded teeth in particular. However, the results of this review should be interpreted with caution because of the number, quality, and heterogeneity of the studies.
The "four principles plus scope" approach provides a simple, accessible, and culturally neutral approach to thinking about ethical issues in health care. The approach, developed in the United States, is based on four common, basic prima facie moral commitments--respect for autonomy, beneficence, nonmaleficence, and justice--plus concern for their scope of application. It offers a common, basic moral analytical framework and a common, basic moral language. Although they do not provide ordered rules, these principles can help doctors and other health care workers to make decisions when reflecting on moral issues that arise at work.
The primary aim was to evaluate the validity of a teledentistry system for screening new patient orthodontic referrals. The secondary aims were to evaluate whether the teledentistry system affected i) referral rates ii) inappropriate referral rates iii) number of failed appointments.
Randomised controlled trial.
Fifteen dental practices in Greater Manchester, UK, were randomly allocated to either a teledentistry test group (n = 8) or a control group (n = 7). They referred 327 patients over a 15 month period.
Practitioners in the test group referred patients to one of two consultant orthodontists via a 'store and forward' teledentistry system consisting of photographs sent as email attachments. The decision to accept or not accept a referral on this basis was compared with the same decision choice when the same patient was subsequently seen on a new patient clinic. This measured the validity of the system with the clinic's decision used as the gold standard. Patients in the control group were referred using the usual letter system. Referral rates, inappropriate referrals and number of failed appointments were then compared between the teledentistry and control groups.
The sensitivity (true positive value) of the teledentistry system was high at 0.80 with a positive predictive value of 0.92. The specificity (true negative value) was slightly lower at 0.73 with a negative predictive value of 0.50. The inappropriate referral rate for the teledentistry group was 8.2% and for the controls 26.2% (p = 0.037). There was no statistically significant difference in clinic attendance between teledentistry and control groups (p = 0.36).
Teledentistry is a valid system for positively identifying appropriate new patient orthodontic referrals. However, there is a risk that a patient is not accepted on the teledentistry system who would benefit from a full clinical examination. Teledentistry could be a significant factor in reducing the inappropriate referral rate. Patient participation in a teledentistry system does not appear to mean they are any more likely to attend their hospital appointment.
The management of an orthodontic practice needs to be highly structured and organized. The actual treatment process obviously benefits from a disciplined clinical approach, which can be facilitated by Standard Operating Protocols and Checklists. In addition to the clinical management of patients, the organizational management of the office itself can be further enhanced by adopting these protocols and checklists. This article provides an introduction to both concepts, with sample protocols and checklists that doctors may use in their offices.
Marketing as a word conjures up different visions for the orthodontic profession. It encompasses so many things and so much variety that it is difficult to discuss it with others in our field. The connotations are so varied that there is so much confusion when you throw in the association of marketing with advertising. Infact, even without knowing about the science of marketing, successful orthodontic practices do incorporate tenets that generate greater patient recall and referrals. The uniqueness, impact, and memorability of patient interaction are critical to generating a consistent referral base. A concept that is, making the industry at large, change its practice is the concept of the “Experience Economy.” In a survey of orthodontic patients, who were asked to rate the best and worst memories of their orthodontic treatment by the Q sort methodology, the best and the worst memories were experience and not therapy based. This article highlights the “Experience Economy Tools” for Internal marketing. With changing times, orthodontic practices that are able to implement these Internal marketing strategies in their day-to-day practice protocols will see improved patient satisfaction outcomes and financially successful practice models that will grow in any economy.
Our College recently convened a series of retreats bringing together faculty, administrators and employees to identify common concerns. Stakeholders working independently in small groups separately and collectively agreed that our major organizational concern was communication. This theme played out in various ways. From not knowing what was going on beyond an individual's immediate work area to broader interpersonal challenges. Some felt a lack of caring or appreciation. Often the word, "respect," was used. Perceived deficiencies extended to students, faculty, administrators, staff, and most troubling, to patients. Communication skills are recognized as essential to professional competence by the Commission on Dental Accreditation, the American Dental Education Association, and the Inter-professional Educational Collaborative. It is a theme that crosses disciplines and is foundational to patient-centered care. As scientifically driven evidence-based healthcare and technologies progress, the emotional, psychological, social and cultural needs of patients may be neglected. Communication skills centered on empathy and showing you care, yield benefits to both the doctor and patient in terms of satisfaction, compliance, and treatment outcomes.
Introduction:
The first straight-wire appliance was introduced over 40 years ago to increase the consistency and efficiency of orthodontic treatment. More recently, computer-aided design and computer-aided manufacturing (CAD/CAM) technology has been used to create individualized orthodontic appliances. The purpose of this study was to investigate the clinical effectiveness and efficiency of CAD/CAM customized orthodontic appliances compared with direct and indirect bonded stock orthodontic brackets.
Methods:
This retrospective study included 3 treatment groups: group 1 patients were direct bonded with self-ligating appliances, group 2 patients were indirect bonded with self-ligating appliances, and group 3 patients were indirect bonded with CAD/CAM self-ligating appliances. Complete pretreatment and posttreatment records were obtained for all patients. The American Board of Orthodontics (ABO) Discrepancy Index was used to evaluate the pretreatment records, and the posttreatment outcomes were analyzed using the ABO Cast-Radiograph Evaluation. All data collection and analysis were completed by 1 evaluator.
Results:
There were no statistically significant differences in the ABO Discrepancy Index or the ABO Cast-Radiograph Evaluation among the groups. Treatment times for the 3 groups were significantly different; the CAD/CAM group was the shortest at 13.8 ± 3.4 months, compared with 21.9 ± 5.0 and 16.9 ± 4.1 months for the direct bonded and indirect bonded groups, respectively. The number of treatment appointments for the CAD/CAM group was significantly fewer than for the direct bonded group.
Conclusions:
The CAD/CAM orthodontic bracket system evaluated in this study was as effective in treatment outcome measures as were standard brackets bonded both directly and indirectly. The CAD/CAM appliance was more efficient in regard to treatment duration, although the decrease in total archwire appointments was minimal. Further investigation is needed to better quantify the clinical benefits of CAD/CAM orthodontic appliances.
The project conceived in 1929 by Gardner Murphy and the writer aimed first to present a wide array of problems having to do with five major "attitude areas"--international relations, race relations, economic conflict, political conflict, and religion. The kind of questionnaire material falls into four classes: yes-no, multiple choice, propositions to be responded to by degrees of approval, and a series of brief newspaper narratives to be approved or disapproved in various degrees. The monograph aims to describe a technique rather than to give results. The appendix, covering ten pages, shows the method of constructing an attitude scale. A bibliography is also given.
Socially disadvantaged children have limited access to orthodontic services. We examined the feasibility of a general dental practitioner providing interceptive orthodontic services to disadvantaged children with real-time supervision from an orthodontist using teledentistry.
Pretreatment and posttreatment orthodontic study models of 30 children treated by a general dentist using teledentistry and 96 children treated by orthodontic residents directly supervised by orthodontic faculty were scored with the peer assessment rating (PAR) index.
Both groups had significant improvements in PAR scores: 35.6% in the teledentistry group and 44.1% in the direct supervision group (P <0.001). There were no significant differences between the groups before treatment or after interceptive orthodontic treatment.
The results of this study suggest that interceptive orthodontic treatments provided by sufficiently prepared general dentists and supervised remotely by orthodontic specialists through teledentistry are a viable approach to reducing the severity of malocclusions in disadvantaged children when referral to an orthodontist is not feasible.
The information presented in this article must be interpreted with caution. Ideally the trial should have lasted longer because five of the seven participating dentists said they felt constrained from taking in more cases because access to TeleDent advice would cease before completion of all but the shortest of treatments. Second, the number of practitioners recruited into the trial was small, and the dentists chosen were highly selected. Third, almost all the data are based on the opinions of the participating dentists, and for three of the dentists the number of cases on which those opinions were based was small. Finally, it must be remembered that all United Kingdom NHS dentists are busy and work on a highly structured "time of service" payment system. Although the costs of hardware, software, line rental, and training were borne by the TeleDent project, there was no financial compensation for the time spent by dentists capturing images of their patient records and putting together the whiteboard and transmitting the information. There was a significant financial disincentive for using the system. Ideally, a long-term prospective randomized study of the effect of teledentistry advice on outcome of orthodontic treatment provided by general dental practitioners should be undertaken. The data collected in the current study supported the dentists' opinions that TeleDent SW enabled them to offer a better service for their patients and use specialist services more appropriately.
About "the way it was
- O Rigsby
- Thoghts
Rigsby O. Thoghts. About "the way it was...". Am J Orthod
Dentofac Orthop. 2018;154(1):4-5. http://dx.doi.org/
10.1016/j.ajodo.2018.04.001.
How dental monitoring works -dental monitoring
How dental monitoring works -dental monitoring;
Accessed 18 June 2018. https://dental-monitoring.com/
how-dental-monitoring-works/.