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Treatment compliance of adolescent orthodontic patients with headgear activator and twin-block appliance assessed prospectively using microelectronic wear-time documentation
Abstract
Background:
Success of orthodontic removable appliance treatment relies on patient compliance. The aim of this quantitative and qualitative study was to explore the compliance and self-reported experience of adolescents in orthodontic treatment with headgear activator (HGA) or twin-block (TB) appliance.
Materials/methods:
The study group comprised 52 adolescents with a mean age of 12.6 (±1.3) years at the start of the treatment. The patients were treated at a free-of-charge public dental clinic. Participants were randomly allocated to two equal groups to be treated with either HGA or TB. Patient compliance was evaluated as appliance wear time and subjective experience. Appliance wear time was recorded with Theramon® microchip, and the self-reported subjective experience using a questionnaire.
Results:
In total, 30 patients completed the treatment during the follow-up period. HGA was worn on average 7 hours per day and TB 9 hours per day by those patients, who successfully completed the treatment. During a mean observation period of 13 months (range 7-23 months), the mean actual wear time was 43 per cent less than the advised 12 or 18 hours per day in the whole patient group, and 55 per cent in those patients, who completed the treatment. Compliance level was unrelated to the appliance type.
Limitations:
Study assessed a relatively small number of patients.
Conclusions/implications:
Adolescent patients wear HGA and TB less than advised. Individual variation in treatment adherence is considerable. Thereby, microelectronic wear-time documentation can be a cost-effective mean of identifying non-compliance.
... The consensus is that the greater the wear, the greater the outcome in terms of overjet reduction. A prospective, cohort study by Arponen et al. (2020) concluded that those who wore their appliances for more than 8 h per day had an overjet reduction of 50% compared to 20% in those who wore their appliances for less than 8 h per day (Arponen et al., 2020). ...
... The consensus is that the greater the wear, the greater the outcome in terms of overjet reduction. A prospective, cohort study by Arponen et al. (2020) concluded that those who wore their appliances for more than 8 h per day had an overjet reduction of 50% compared to 20% in those who wore their appliances for less than 8 h per day (Arponen et al., 2020). ...
... Self-reported wear has been shown to be unreliable, with patients, parents and orthodontists overestimating the amount of time appliances have been worn. Arponen et al. (2020) found that patients' mean self-reported wear was 1.8 ± 5.4 h higher than actual wear time recorded by Theramon ® sensors (Arponen et al., 2020). Those who keep wear diaries have been shown to demonstrate more compliance with headgear than those who do not (Cureton et al., 1993). ...
Abstract
Aims:
The aim of this study was to evaluate whether text reminders influence patient compliance with Twin Block appliances. The null hypothesis was that there was no statistically significant differences in Twin Block compliance between those who receive text reminders and those that do not.
Design:
Single-blind parallel randomised controlled clinical trial.
Setting:
Health Service Executive (HSE) orthodontic outpatient clinic in Dublin, Ireland.
Participants:
A total of 59 patients aged 11–15 years with a 5a Index of Orthodontic Treatment Need (IOTN grade) starting treatment with Twin Block appliances.
Methods:
A computer-generated unstratified allocation sequence was used to randomise the participants into the control group (CG) or the text group (TG). Both groups were asked to wear their appliances full-time. In addition to the same verbal and written instruction received by the CG, the TG received text message reminders to wear their appliances every 3 days. The primary outcome measure was wear time reported by Theramon® sensors embedded in the appliances. Data on wear time were uploaded from the Theramon® sensors onto cloud software. Participants in both groups were asked to fill out wear diaries and submit these at each visit. Treating clinicians and the primary investigator were blinded to the allocation group. Participants were followed up for 4 months. Participants were not blinded to their treatment group.
Results:
In total, 29 participants were allocated to the CG and 30 to the TG. The data for 53 participants were analysed, 24 from the CG and 29 from the TG. The median hours/day of wear recorded using the Theramon® sensors was 13.77 (interquartile range [IQR] = 10.19) for the CG and 17.72 (IQR = 5.62) for the TG. The difference in wear time recorded was not statistically significant (P = 0.16).
Conclusion:
The study concluded that text message reminders had no statistically significant influence on patient compliance with Twin Block appliances.
... Patients seem to wear the appliance mainly during the nights due to speech difficulties and/or inconvenience in leisure-time activities. Similar differences in recommended wear-time and actual wear-time have been reported in earlier studies on treatments with Twin Blocks or other kinds of removable appliances (17,31,32). ...
... The molar relationship was normalized in the majority of the patients. The results are in line with other studies, which have shown that the Twin Block was effective, even if the patients used the appliance less than instructed (8,9,32). It might be beneficial to consider a shorter wear-time instruction than 12-14 hours per day to strengthen patient compliance. ...
... In addition, the number of patients included in the study was still acceptable in relation to the power calculation. The present study used a validated method for measuring wear-time, which should reduce the risk of measurement error (22)(23)(24)26,32). The position of the TheraMon® sensor is reported to affect the accuracy of wear-time measurements. ...
Background
Compliance is crucial for the treatment outcome with removable appliances. Previous studies on treatment with the Twin Block appliance have focused on effectiveness in relation to other treatment methods or wear-time. Studies on different check-up intervals to improve compliance seem to be lacking.
Objectives
To compare the impact of two different check-up prescriptions on patient compliance and treatment outcome during treatment with Twin Block.
Trial Design
Two-arm parallel group, single-centre, randomized controlled trial.
Materials and Methods
Seventy-three patients, 38 boys, and 35 girls, mean age 11.2 years, were included and block-randomized into two groups treated with a Twin Block appliance. Group 1 was called for check-up visit every sixth week and group 2 every fourth week. Compliance was evaluated with a TheraMon® microsensor, moulded into the appliance, measuring wear-time. Overjet, overbite, and molar relationships were assessed on study casts before and after treatment. The treatment outcomes were analysed on an intention-to-treat basis.
Results
In group 1, the reduction of overjet was 5.2 mm and the mean wear-time was 6.9 hours. In group 2, the reduction was 4.7 mm and the wear-time was 6.1 hours. Seventy-four per cent of the patients presented an overjet of 4 mm or less. Wear-time did not correlate to age, gender, or severity of malocclusion.
Harms
No harm was observed in any patient. Lateral open bites were registered during treatment but were normalized at the end of the treatment.
Limitations
The trial was a single-centre study and long-term effects were not evaluated.
Conclusions
During treatment with the Twin Block appliance, a 4-week check-up interval did not improve treatment outcome or increase wear-time, compared to a 6-week check-up interval. The mean wear-time was 6.5 hours per day, even if the recommendation was 12 hours.
Clinical Trial Registration
NCT05155774
... 8 Sex of the participants was reported in most studies, with the exception of 2 articles. 16,17 The minimum observation period was 30 days, 12 ...
... The influence of patient age on DWT was assessed only in 17 studies. In 10 of them, 7,8,[16][17][18]20,21,25,29,31 mean DWT was found to decrease with patient age, whilst in the remaining 7, 9,23,26,28,36,39,40 no such relationship was found. Schott et al 22 found that mean DWT is closest to doctors' recommendations in boys aged 11 to 13 years, and it is shortened both below and above this age range. ...
... In the opinion of many authors, 8,17,37 good patient compliance with the recommended DWT during treatment with removable appliances is associated with their ease of use, low failure rate, and lack of discomfort. The results of our study, on the other hand, show that better compliance (aDWT = 86.42%) ...
Objectives
The aim of this review was to determine whether the type of removable appliance, as well as the age and sex of the patient, may affect the extension or reduction of wear time by assessing the correlation between the mean actual and orthodontist-recommended wear times.
Methods
Randomised case control trials, cohort studies, case series, observational studies, reviews, and retrospective analyses were identified. The quality of the studies was assessed using the Cochrane Collaboration Tool and modified Newcastle-Ottawa Scale. The electronic databases Embase, PubMed, Scopus, and Web of Science were reviewed, and 542 articles were obtained, of which 31 were qualified for qualitative synthesis. The data from 1674 participants were collected and a weighted average was determined for the mean wear time of each appliance.
Results
Regardless of the type of extra- or intraoral appliances, mean wear time was shorter than recommended, although patients using intraoral appliances cooperated more. The best compliance was noted for Schwarz appliances (73.70%) and plate retainers (85%). There was no evidence of an influence of patients’ age and sex on compliance during treatment.
Conclusions
The considerable inconsistency and imprecision of articles could affect the reliability of the results. Previous studies analysing the effectiveness of treatment with removable appliances based on an arbitrarily assumed average wear time need to be revised in order to verify the actual wear time with the use of microsensors.
... Smart Retainer microsensors (14,15), Thermonchron i-Button (9), Smartgear (39), Air Aid Sleep, and DentiTrac (25) were also used. Subjective measurements were carried out by way of a questionnaire in 10 of the studies (9,13,15,17,27,28,34,35,37,40). ...
... Patients of 14 studies (13, 17, 18, 21-23, 28, 29, 31, 33, 35-38) were informed that their adherence would be monitored by way of the microsensor, while in 8 other articles (9,16,19,20,40) the presence of microsensors was not revealed to patients. Four studies include both patients being informed of monitoring and patients not being aware (14,15,19,34). ...
... Several authors agree that patients tend to overestimate their wear hours during treatment when they are unaware of the presence of the microsensor (9,19,20,40), and it also occurs when they are aware of monitoring (18,28,35). ...
Background/objective
Patient compliance during orthodontic treatment is one of the factors that most affects success in the final result. The use of removable appliances is frequent at an early age and the monitoring of its use is essential to assess the collaboration of the patient. The aim of this study was to establish the effectiveness of microsensors included in removable appliances during orthodontic treatment or in the retention phase to enable a reliable and individualized follow-up of the patient.
Search methods
The article search was carried out in various electronic databases and journals without any language restrictions.
Selection criteria
Studies using microsensors into removable appliances were selected with the key selection criterion of a minimum follow-up of 4 weeks.
Data collection and analysis
The quality of the studies included was evaluated using the Cochrane scale for the randomized controlled trials and the Newcastle Ottawa Scale for control–case, cohort, and transversal studies. The mean of the differences with a 95% confidence interval was expressed for the continuous data.
Results
Twenty-nine full-text articles were analysed and included in the qualitative synthesis. In general, the mean daily wear time of removable appliances measured objectively was less than the time that the professional had predetermined.
Conclusions
The use of microsensors as an objective measurement method enhances communication and boosts confidence in the orthodontist–patient relationship. More random clinical studies with temperature sensors are needed to establish to what extent they influence the orthodontic outcome.
Registration
PROSPERO (CRD42019120525).
... Mikroczujnik odczytuje i zapisuje aktualną temperaturę (z zakresu od 33,5°C do 39,5°C z dokładnością do 0,1°C) co 15 minut. Odczytane wartości są rejestrowane w pamięci wewnętrznej urządzenia [11,16,17,18]. Możliwe jest także przesyłanie danych do 30 aplikacji mobilnej w telefonie. ...
... Korzystne właściwości fizyczne urządzenia takie jak małe wymiary (13x9x4 mm) i niewielka waga (0,4g) umożliwiają jego integrację z różnymi rodzajami aparatów zdejmowanych, w tym aparatów retencyjnych [21]. Pozwala to na szybką interwencję lekarza ortodonty w przypadku słabej współpracy [17]. ...
Introduction Removable retainers have been successfully used for many years as an independent or additional form of retention in patients after orthodontic treatment. Unfortunately, it has been proven that most patients do not follow the orthodontist's recommendations and do not use the braces for the number of hours necessary to stabilize the treatment effects. It has therefore become necessary to look for solutions and devices that are able to objectively record the actual time of retainers use. Aim of the study The aim of the study was to assess the usefulness of electronic microsensors in monitoring wear time of removable retainers. Materials and methods A search was conducted using PubMed, Google Scholar, ResearchGate databases. Articles were searched in English using the following key words: “microsensors”, “retention”, “orthodontic”, “TheraMon”, “Smart Retainer”. Results The results of the literature review show that microsensors embedded in the elements of removable retainers are a valuable tool for monitoring the time of their use. Awareness of the presence of electronic sensors increases patient discipline. In addition, they provide data that, apart from objectively documenting the course of retention treatment, may be used in the future to determine optimal retention protocols. Conclusions The retention stage is an indispensable element of orthodontic treatment. The use of microsensors built into removable retainers can help to improve the stability of treatment results. However, further research and work are needed to improve the performance and reliability of this type of electronic sensors.
... However, a randomized controlled trial [7] concluded that PT-wearing is sufficient for FTMA. Therefore, in a series of follow-up clinical studies [8][9][10], removable FTMA appliances were even investigated for their therapeutic effectiveness following PT-wearing protocols. Naturally, this has sparked controversy [11,12]. ...
... To date, however, conclusions of MA effectiveness alteration due to different wearing times are basically drawn from clinical studies [7][8][9][10]. This is largely influenced by patient compliance, which renders a situation of lacking solid and unbiased evidence of histological evaluation and biological mechanisms from reliable fundamental experiments conducted with animal models. ...
Objectives
This study was aimed at resolving the controversy over the wearing time of mandibular advancement (MA) appliances by comparing the differences between part-time and full-time MA (PTMA and FTMA) from the perspective of promoting H-type vessel coupling osteogenesis in the condylar heads.
Materials and methods
Thirty 30-week-old male C57BL/6J mice were randomly divided into 3 groups: the control (Ctrl), PTMA, and FTMA groups. The mandibular condyles were analyzed by morphology, micro-computed tomography, histological staining, and immunofluorescence staining to investigate the changes of the condylar heads in the PTMA and FTMA groups after 31 days.
Results
Both PTMA and FTMA models promoted condylar growth and achieved stable mandibular advancement at day 31. However, compared with PTMA, FTMA has the following characteristics. First, new bone formation in the condylar head was detected in the retrocentral region in addition to the posterior region. Second, the condylar proliferative layer was thicker, and the number of pyknotic cells in the hypertrophic and erosive layers was higher. Moreover, endochondral osteogenesis of the condylar head was more active. Finally, the retrocentral and posterior regions of the condylar head had more vascular loops or arcuate H-type vessel coupling Osterix⁺ osteoprogenitors.
Conclusions
While both PTMA and FTMA induced new bone formation in the condylar heads of middle-aged mice, FTMA promoted more osteogenesis by volume and region. Furthermore, FTMA presented more H-type vessel coupling Osterix⁺ osteoprogenitors in both the retrocentral and posterior regions of the condylar head.
Clinical relevance
FTMA is better at promoting condylar osteogenesis, especially in non-growing patients. We suggest that enhancing H-type angiogenesis could be an effective strategy to achieve favorable MA outcomes, especially for patients unable to meet the FT-wearing requirement or being non-growing.
... Fifteen patients were found to be sufficient to achieve power over 80% with a 95% confidence interval (CI) and an a of 0.05 to find a meaningful difference of 1.3 standard deviation (SD) units between the groups, as reported previously. 26 Therefore, 30 patients between 10 and 15 years old were recruited who were seeking orthodontic treatment at Istanbul University Orthodontics Clinic. Inclusion criteria were; skeletal Class II division I patients with mandibular retrognathia and convex profile, without systemic disease or syndrome and no history of previous removable appliance therapy. ...
... A significant difference was not detected between the objective wear times of monoblock appliances and those of twin-block appliances, supporting the findings of studies that suggested that appliance type did not affect patient compliance. 20,26 As presented in a recent systematic review, subjective compliance data derived from patients tended to be 5-6 hours more optimistic than that of the objective wear-time data. 14 All of the patients in the current study, all of whom noted their wear time daily on a chart, overestimated their wear time by an average of 3.76 hours, which was 15.6% higher than that of the real daily compliance levels. ...
Objectives
To assess the objective compliance levels in skeletal Class II patients with mandibular retrognathia wearing monoblock and twin-block appliances.
Materials and Methods
A prospective clinical study was conducted with 30 patients between 10 and 15 years old who were equally divided into two study groups. Group 1 was treated with monoblock, and group 2 was treated with twin-block appliances. The patients were instructed to wear their appliance for 15 hours per day. Wear times were monitored by a microsensor. (TheraMon; MCTechnology, Hargelsberg, Austria) for an average of six appointments. Patients were also instructed to record their wear times on a chart, and this record was admitted as subjective wear time. Statistical analysis was performed with the data derived from both the patients' charts and the monitoring records.
Results
The mean wear time by the patients was 10.67 ± 3.93 hours, which was less than the 15 hours prescribed by the orthodontist, with no difference between the two appliances (P > .05). The regular use rate, which included the days with a wear time of 8 hours or more per day, was 75%. Compliance levels decreased by 35% throughout the six control appointments. Patients declared that their wear time was more than their objective wear time by an average of 3.76 hours.
Conclusions
Despite their different designs, there was no significant difference between the monoblock and twin-block appliances in terms of compliance.
... However, the twin block appliance is a removable appliance that needs to be worn an adequate amount of time per day to achieve adequate treatment results. [6][7][8] Orthodontic literature showed that different authors proposed functional appliances able to correct class 2 malocclusion using composite resin bites bonded, on posterior segments of both arches and presenting inclined planes designed to promote mandibular anterior advancement. [9][10][11][12] These authors named the same appliance in different ways: Planas direct tracks, 11,12 bonded inclined bite raisers, 10 and posterior functional bite turbos. ...
... First, it is one of the first reports to demonstrate the effect of e-reminders on improving patient compliance during CAT treatment. This finding is particularly significant as the literature indicates that orthodontic patients seeking treatment with removable appliances often fail to adhere to wearing times [41][42][43] or sometimes do not complete the prescribed therapy at all 44 . Another strength is that it used real-world data and employed the ITS approach. ...
Patient compliance is relevant to achieving therapeutic goals during clear aligner therapy (CAT). The aim of this study was to evaluate the efficacy of remote electronic (e-)reminders and e-feedback on compliance during CAT using an interrupted time series (ITS) analysis. We used routinely collected mobile application data from a German healthtech company (PlusDental, Berlin). Our primary outcome was self-reported compliance (aligner wear time min. 22 h on 75% of their aligners were classified as fully compliant, min. 22 h on 50–74.9% of their aligners: fairly compliant; min. 22 h on < 50% of their aligners: poorly compliant). E-reminders and e-feedback were introduced in the 1st quarter of 2020. Compliance was assessed at semi-monthly intervals from June-December 2019 (n = 1899) and June-December 2020 (n = 5486), resulting in a pre- and post-intervention group. ITS and segmented regression modelling were used to estimate the effect on the change in levels and trends of poor compliance. Pre-intervention, poor compliance was at 24.47% (95% CI: 22.59% to 26.46%). After the introduction of e-reminders and e-feedback (i.e., post-intervention), the percentage of poorly compliant patients decreased substantially, levelling off at 9.32% (95% CI: 8.31% to 10.45%). E-reminders and e-feedback were effective for increasing compliance in CAT patients.
Clinical Significance: Orthodontists and dentists may consider digital monitoring and e-reminders to improve compliance and increase treatment success.
... During orthodontic treatment, precisely controlled anchorage (inhibition of undesired tooth movement to enhance favorable tooth movement) is often critical to effectively establish a stable, highly functional occlusion. Contemporary orthodontists utilize various mechanical techniques to enhance orthodontic anchorage, but such techniques can lead to negative side effects, and are dependent upon patient compliance and/or an appropriate anatomic location for placement (Cole, 2002;Jambi et al., 2013;Janson et al., 2013;Jambi et al., 2014;Kuroda and Tanaka, 2014;Al-Awadhi et al., 2015;Arponen et al., 2020). In addition, even appliances that utilize skeletal anchorage, such as temporary anchorage devices (TADs), while effective, do not provide 100% anchorage (Jambi et al., 2014;Kaipatur et al., 2014;Becker et al., 2018). ...
Orthodontic treatment commonly requires the need to prevent movement of some teeth while maximizing movement of other teeth. This study aimed to investigate the influence of locally injected nitric oxide (NO) releasing nanoparticles on orthodontic tooth movement in rats.
Materials and methods:
Experimental tooth movement was achieved with nickel-titanium alloy springs ligated between the maxillary first molar and ipsilateral incisor. 2.2 mg/kg of silica nanoparticles containing S-nitrosothiol groups were injected into the mucosa just mesial to 1st molar teeth immediately prior to orthodontic appliance activation. NO release from nanoparticles was measured in vitro by chemiluminescence. Tooth movement was measured using polyvinyl siloxane impressions. Bones were analyzed by microcomputed tomography. Local tissue was assessed by histomorphometry.
Results:
Nanoparticles released a burst of NO within the first hours at approximately 10 ppb/mg particles that diminished by 10 × to approximately 1 ppb/mg particles over the next 1-4 days, and then diminished again by tenfold from day 4 to day 7, at which point it was no longer measurable. Molar but not incisor tooth movement was inhibited over 50% by injection of the NO releasing nanoparticles. Inhibition of molar tooth movement occurred only during active NO release from nanoparticles, which lasted for approximately 1 week. Molar tooth movement returned to control levels of tooth movement after end of NO release. Alveolar and long bones were not impacted by injection of the NO releasing nanoparticles, and serum cyclic guanosine monophosphate (cGMP) levels were not increased in animals that received the NO releasing nanoparticles. Root resorption was decreased and periodontal blood vessel numbers were increased in animals with appliances that were injected with the NO releasing nanoparticles as compared to animals with appliances that did not receive injections with the nanoparticles.
Conclusion:
Nitric oxide (NO) release from S-nitrosothiol containing nanoparticles inhibits movement of teeth adjacent to the site of nanoparticle injection for 1 week. Additional studies are needed to establish biologic mechanisms, optimize efficacy and increase longevity of this orthodontic anchorage effect.
... Another limitation was that the authors failed to specify the severity of the malocclusion. Since TB is often seen as the removable FA with the highest compliance, the sole focus on the TB appliance makes it difficult to generalize the conclusions to other functional appliances (31). ...
Background:
Patients with dental and skeletal Class II growth patterns present typical facial characteristics. Functional appliance (FA) therapy is one of the conventional orthodontic treatment modalities used to harmonize these facial imbalances.
Objectives:
The aim of this systematic review was to investigate and summarize the effects of FAs on the facial soft tissues captured in three dimensions.
Search methods:
A systematic search was conducted up to December 2020. Databases Medline (via PubMed), Embase (via Ovid), Web of Science, and Cochrane Central were searched without language restrictions.
Selection criteria:
Randomized clinical trial (RCT)'s investigating the influence of FA therapy on the facial soft tissues in a non-cephalometric and three-dimensional (3D) manner, were included.
Data collection and analysis:
Data extraction was independently undertaken by two authors. In case of conflict, a third author was consulted. RoB 2.0 tool was used to assess the risk of bias. A meta-analysis was performed for total facial height, upper lip length, lower lip length, commissural width, and facial depth. The single-step activation versus incremental approach was compared using a random effects model.
Results:
Five studies were included in the qualitative synthesis of the systematic review. Facial height increased after FA therapy. Three studies met the criteria for the meta-analysis. The mean facial depth increased significantly (P < 0.003) with 1.39 mm (0.46 to 2.32).
Conclusions:
Current evidence suggests a positive influence of the FA therapy on the soft tissues in Class II patients. However, conclusions were drawn based on a two-dimensional analysis of 3D images, suggesting that more controlled studies using a comprehensive 3D analysis are necessary to confirm these results.
Registration:
PROSPERO registration (CRD 42021224016).
... A limitation of the present study was that patients' compliance was obtained from the clinical chart after interviewing each patient and also his/her parents at each appointment. Nowadays objective methods to assess patients' compliance with removable appliances are available (sensors) and they should be used increasingly in clinical studies [37,38]. ...
Background
To detect the optimal timing of intervention based on different cervical vertebral maturation stage (CS1-2 vs. CS3-4) for the treatment of Class III malocclusion with early Class III protocol.
Methods
A total sample of 43 patients (23 females, 20 males) ranging between 7 and 13 years of age with dentoskeletal Class III malocclusion treated with the modified SEC III (Splints, Elastic and Chincup) protocol divided into two groups based on the cervical vertebral maturation stages (CS1-2 and CS3-4) was included in this retrospective observational longitudinal study. Patient compliance was assessed using a 2-point Likert scale. Statistical comparisons between the two groups were performed with independent sample t tests.
Results
No statistically significant differences for any of the cephalometric variables describing the baseline dentoskeletal features were found between the two groups except for the mandibular unit length that was significantly greater in the pubertal group ( P = 0.005). The modified SEC III protocol produced favorable sagittal outcomes in both groups, whereas no statistically significant T1-T2 changes were found between the CS1-2 and CS3-4 groups for any of the angular and linear measurements. No significant differences were found in the prevalence rates of the degree of collaboration between the two groups ( P = 1.000).
Conclusions
No significant differences between prepubertal and pubertal patients were found in the sagittal and vertical dentoskeletal changes with the modified SEC III protocol. Thus, this early Class III treatment produced similar favorable effects in growing subjects regardless of the cervical vertebral maturation stages from CS1 to CS4.
... 27 Temperature microsensors, described above, are now commonly used in functional appliances with and without headgear. [28][29][30] A significant discrepancy between objective and subjective reports in orthodontic appliance use has been shown in systematic review of these indwelling devices with a mean discrepancy of 5 hours a day between selfreported and objectively assessed appliance wear, ranging from nearly 6 hours a day for extra-oral headgears to just more than 3 hours for upper removable appliances that attach on a single jaw. 31 Factors that influence patient adherence to nighttime orthodontic retainers looked into the effects of age, sex, type of retention device (single-jaw Hawley retainer or functional appliance retainer), place of treatment (university hospital or private orthodontic practice), and health insurance status (statutory health insurance or private health insurance). ...
Long-term effective therapy is essential for obstructive sleep apnea (OSA) control and preventing comorbidity. OSA patients are often reported to be more receptive to oral appliance therapy over positive airway pressure (PAP). Oral appliance usage can now be objectively recorded by temperature microsensors. Studies using commercially available microsensor chips have reported data out to 1 year, with high rates of adherence (>80%), albeit in small samples. There is opportunity to further use this technology to understand individual adherence factors and patterns and in obtaining objective measures of treatment effectiveness, particularly for longer-term health outcomes and allowing comparison to PAP.
Objective
This study was undertaken to determine contemporary trends in the use of the Twin Block appliance among UK orthodontists, including the wear time currently prescribed. In addition, the study explored if there had been any change in wear time prescribed, considering recent research evidence proposing part-time wear.
Design
Cross-sectional, online survey.
Participants
Members of the British Orthodontic Society (BOS).
Methods
The questionnaire was emailed to all BOS members in November 2021 and hosted on the QualtricsXM platform. The questionnaire was piloted for content validity and tested for reliability.
Results
A response rate of 19% was attained. Nearly all (n = 244, 99%) participants used the Twin Block, and 90% (n = 218) prescribed full-time wear including/excluding eating. Although the majority (n = 168, 69%) had not made changes to their wear time prescriptions, nearly one-third (n = 75, 31%) had. Those who reported a change in their prescriptions currently prescribe less wear time than before, and commonly quoted ‘research evidence’ as the reason. A wide range in success rates (41%–100%) was reported, with patient compliance as the main reason for treatment discontinuation.
Conclusion
The Twin Block is a popular functional appliance among orthodontists in the UK, originally designed by Clark to be worn full time to maximise functional forces applied to the dentition. However, this wear regime may place considerable strain on patient compliance. Most participants prescribed full-time Twin Block wear excluding eating. Approximately one-third of orthodontists made changes to their wear time prescriptions during their practising career, and currently instruct less wear time than before.
Wearable technology to augment traditional approaches are increasingly being added to the arsenals of treatment providers. Wearable technology generally refers to electronic systems, devices, or sensors that are usually worn on or are in close proximity to the human body. Wearables may be stand-alone or integrated into materials that are worn on the body. What sets medical wearables apart from other systems is their ability to collect, store, and relay information regarding an individual’s current body status to other devices operating on compatible networks in naturalistic settings. The last decade has witnessed a steady increase in the use of wearables specific to the orofacial region. Applications range from supplementing diagnosis, tracking treatment progress, monitoring patient compliance, and better understanding the jaw’s functional and parafunctional activities. Orofacial wearable devices may be unimodal or incorporate multiple sensing modalities. The objective data collected continuously, in real time, in naturalistic settings using these orofacial wearables provide opportunities to formulate accurate and personalized treatment strategies. In the not-too-distant future, it is anticipated that information about an individual’s current oral health status may provide patient-centric personalized care to prevent, diagnose, and treat oral diseases, with wearables playing a key role. In this review, we examine the progress achieved, summarize applications of orthodontic relevance and examine the future potential of orofacial wearables.
Background
The aim of this study was to investigate the association between objective wear time and treatment efficacy of a twin block (TB) appliance.
Methods
A TB appliance incorporating a compliance indicator was delivered to 44 children in the age group of 11—14 years (25 boys and 19 girls). Participants were instructed to wear the appliance full time and were recalled at 3—4- week intervals. Cephalograms and study models were taken at baseline and after 6 months of appliance therapy.
Results
Data from 41 of the 44 participants were analyzed. A wide variation in daily wear time among participants was observed. Based on wear time, they were divided into full time (FT >17 h/d) and part time (PT < 12 h/d) wear groups. Mean wear durations were 20.86 hours in the FT-wear group and 9.55 hours in the PT-wear group. In skeletal changes, the ANB (A point, nasion, B point) angle was reduced by 2.69° in the FT-wear group, and 1.33° in the PT-wear group, and statistically significant increases were seen for the mandibular base measurement (Pg/OLp) in the FT-wear group (2.22mm), compared with those in the PT-wear group (0.44mm). . In dental changes, overjet were reduced by 3.91 mm and 2.0 mm in the FT-wear and PT-wear group, respectively. This difference was statistically significant.
Conclusions
Skeletal effects were pronounced in the FT-wear group, and dentoalveolar changes were comparable in the 2 wear groups. The maximum skeletal treatment effect of a TB appliance was found to occur with FT wear over a 6-month treatment period.
Background:
The aim of the current systematic review was to compare the radiologic effects of functional appliance Class II treatment compared to no treatment on the temporomandibular joint and its components.
Methods:
Nine databases were searched up to June 2019 for randomized or prospective non-randomized clinical trials comparing Class II patients treated with functional appliances to untreated patients. After duplicate study selection, data extraction, and risk of bias assessment with the Cochrane tool and the ROBINS-I tool, random effects meta-analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by the assessment of the quality of evidence with GRADE.
Results:
A total of 11 papers on 8 unique trials with 377 patients (39.8% male; average age 10.3 years) were finally included. Limited evidence indicated that compared to untreated growing patients functional appliance treatment was associated with increased condylar width (2 studies; MD 1.1 mm; 95% CI 0.1 to 2.2 mm; very low evidence quality), decreased anterior joint space (2 studies; MD - 0.7 mm; 95% CI - 0.5 to - 0.9 mm; very low evidence quality), increased superior joint space (2 studies; MD 0.7 mm; 95% CI 0.5 to 1.0 mm; very low evidence quality), increased posterior joint space (2 studies; MD 1.0 mm; 95% CI 0.9 to 1.2 mm; very low evidence quality), and vertical displacement of the glenoid fossa (2 studies; MD 0.4 mm; 95% CI 0.1 to 0.7 mm; very low evidence quality). The main limitations affecting the validity of the present findings were the inclusion of non-randomized studies with methodological issues, imprecision due to limited samples of the included studies, and inconsistencies among studies.
Conclusions:
Currently existing evidence from controlled clinical studies on humans indicates that functional appliance treatment is associated with positional and skeletal alterations of the temporomandibular joint in the short term compared to untreated controls. However, the clinical relevance of these changes remains unclear, while the quality of existing evidence is low due to methodological issues of existing studies.
Review registration:
PROSPERO, CRD42018109271.
Background:
The TheraMon® microsensor is the most recent device developed to measure the wear-time of removable appliances. The accuracy has not been validated intraorally.
Objectives:
To determine 1) if the TheraMon® microsensor accurately records time when fixed intraorally, and 2) the effect of the intraoral location on the recorded time.
Methods:
A prospective pilot study, using a convenience sample, was carried out in a UK hospital orthodontic department. Five non-patient volunteers wore microsensors positioned palatal to an upper molar, and buccal to a lower molar for 7 days. Differences between actual amount of wear and the wear recorded by each device were calculated. Differences between sites were also examined.
Results:
The mean daily wear-time recorded by the upper and lower microsensors combined was 23 hours (95% CI 22.6-23.4), which is a mean under-recording of 4% (CI 2.5-5.8%). The maximum daily under-reporting of wear times was 5.5 hours. Microsensors in the lower buccal sulcus recorded wear-times that were closer to actual wear-times.
Conclusions:
Assumptions made by the TheraMon® microsensors software lead to under-reporting of intraoral wear-time, particularly when placed palatally. These discrepancies could be significant in both clinical practice and research. Adjustment of the microsensor software parameters would improve accuracy, irrespective of the intraoral location.
Objective:
The objective of the present study is to compare the effects on soft tissue profile in class II patients after treatment with either "Functional Mandibular Advancer" (FMA) or Herbst appliance.
Materials and methods:
The study included n = 42 patients treated with either FMA (n = 21) or Herbst appliance (n = 21) by the same experienced orthodontist. The treatment followed a single-step advancement protocol. Lateral cephalograms were analyzed through a set of customized measurements. The actual therapeutic effect was calculated using data from a growth survey. After testing for normal distribution and homogeneity of variance, data were analyzed by one-sample Student's t tests and independent Student's t tests. Statistical significance was set at p < 0.05.
Results:
For both FFAs, significant upper lip retrusion, increase in lower lip's thickness, and length of the lower face occurred. Additionally, significant lower lip retrusion and straightening of the profile were found in FMA and Herbst appliance patients. All remaining variables revealed no significant differences.
Conclusions:
Treatment-related changes on the facial soft tissue profile could be regarded similar in class II patients treated with FMA or Herbst appliance. No treatment-related changes that were specific for FMA or Herbst appliance could be identified. Only moderate changes were noted comparing pre- and posttreatment soft tissue profiles.
Clinical relevance:
Despite proven differences in skeletal and dental treatment effects, the facial profile has not to be taken into consideration when choosing between FMA and Herbst appliance for class II treatment.
Introduction:
The primary aims of this systematic review were to assess objective levels of wear of removable orthodontic appliances and components vs both stipulated and self-reported levels. We also aimed to consider patient experiences and the effectiveness of interventions geared at enhancing compliance.
Methods:
Electronic databases and reference lists of relevant studies were searched with no language restriction (PROSPERO: CRD42016036059). Randomized and nonrandomized controlled trials, prospective cohort studies, case series, qualitative and mixed-methods studies objectively assessing compliance levels were identified. The quality of the studies was assessed using the Cochrane Collaboration's risk of bias tool, risk of bias in non-randomized studies of interventions (ROBINS-I), or mixed-methods appraisal tool based on their design.
Results:
Of 4269 records, 80 full texts were obtained, with 24 studies meeting the selection criteria. Of these, 11 were included in the quantitative synthesis. A weighted estimate of objectively assessed compliance levels in relation to stipulated wear time was calculated with the discrepancy highest in the headgear group (5.81 hours per day, 95% confidence interval, 4.98, 6.64) based on 6 studies. The mean discrepancy between self-reported and objectively assessed headgear wear was 5.02 hours per day (95% confidence interval, 3.64, 6.40). Compliance level was not directly related to appliance type (P = 0.211). Thematic synthesis was not undertaken because of the limited number of qualitative studies.
Conclusions:
Compliance with removable orthodontic appliances and adjuncts is suboptimal, and patients routinely overestimate duration of wear. Techniques for improving compliance have promise but require further evaluation in high-level research.
The purpose was to compare the treatment effects of functional appliances activator-headgear (AH) and Twin Block (TB) on skeletal, dental, and soft-tissue structures in class II division 1 malocclusion with normal growth changes in untreated subjects. The sample included 50 subjects (56% females) aged 8–13 years with class II division 1 malocclusion treated with either AH ( n=25 ) or TB ( n=25 ) appliances. Pre- and posttreatment lateral cephalograms were evaluated and compared to 50 untreated class II division 1 cases matched by age, gender, ANB angle, and skeletal maturity. A paired sample, independent samples tests and discriminant analysis were performed for intra- and intergroup analysis. Treatment with both appliances resulted in significant reduction of skeletal and soft-tissue facial convexity, the overjet, and the prominence of the upper lip in comparison to untreated individuals ( p<0.001 ). Retroclination of maxillary incisors and proclination of mandibular incisors were seen, the latter being significantly more evident in the TB group ( p<0.05 ). Increase of effective mandibular length was more pronounced in the TB group. In conclusion, both AH and TB appliances contributed successfully to the correction of class II division 1 malocclusion when compared to the untreated subjects with predominantly dentoalveolar changes.
The aim of this qualitative study was to explore and describe adolescents' experiences of treatment with removable functional appliances.
Public Dental Service, Gothenburg, Sweden.
Individual interviews focusing on adolescents' experiences of using a removable functional appliance were held with 21 adolescents (12 girls and nine boys). The mean age of the participants was 13.2 years (range 11-15, SD 1.25) at the interview occasion. Interviews were transcribed verbatim and analysed according to a qualitative research approach, phenomenography.
Outcomes of data analysis emerged in five categories with totally 12 subcategories that describe the adolescents' various conceptions of the treatment. The adolescent's experiences of using removable functional appliance appeared to have a large variation, comprising of the individual approach, feelings and strategies, the dentist role and receiving external support.
Participants developed their own strategies of measurement to see improvement. An active involvement of the adolescents' in the treatment seems to be needed, supported by the dentist at coming appointments, using overjet measurement as a tool for motivation. Furthermore, efforts should be made by clinicians to listen and understand adolescents' needs and requirement before the treatment start.
© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Objective:
To evaluate the compliance of patients while wearing maxillary Hawley retainers embedded with SMART microsensors.
Methods:
The sample population consisted of 22 patients who were divided into an experimental (group A) and a control group (group B). Group A was informed that they would be monitored through the use of SMART microsensors, while group B was not informed that they would be monitored. After the delivery of the retainers (T0), the patients were evaluated at T1 and T2, represented by 6- and 12-week follow-up visits, respectively. At T1, group B was informed of our ability to monitor their compliance. Both groups continued wearing their retainers during T1 to T2.
Results:
During T0-T1, Group A wore their retainers for an average of 16.3 hours (SD 4.39), while group B wore their appliances for an average of 10.6 hours (SD 5.36, t = 2.426, P = .027). Although group B increased their retainer wear by 0.5 hours/day from T1 to T2, this increase was not statistically significant.
Conclusions:
Despite significant differences being noted between the two groups at T1, group B did not show significant mean changes in their wear time before and after becoming aware of the use of the SMART microsensor.
Objective:
To assess objectively patient compliance with removable orthodontic appliances and the effect of possible influential factors.
Materials and methods:
Wearing times of 45 White patients were recorded with the aid of the TheraMon microsensor. Patient compliance was assessed relative to wear prescription and other parameters, such as age and sex.
Results:
There was high individual variation in most measured variables and in all groups/subgroups. During a median observation period of 186 days (range, 55-318 days) the actual wear time was 9.0 h/d (range, 0.0-16.0 h/d) and did not differ between distinct prescriptions (P = .49). Eight patients wore their appliances less than 2 h/d, and six of them did not wear their appliances at all. Overall, the median wear per day relative to prescription was 62.5% (range, 0.0-89.3%) for the 14 h/d and 112.5% (range, 0.0-200.0%) for the 8 h/d prescription wear (P = .01) groups. There was a strong negative correlation of age (median: 12.5 years) with the daily percentage of actual wear time per day relative to wear prescription (14 h/d prescription: n = 21, rho = -0.61, P = .00; 8 h/d prescription: n = 24, rho = -0.73, P = .00), while sex did not exert a significant influence on compliance (P = .58).
Conclusions:
Despite the fact that patients and parents were informed about wear time recording, compliance was insufficient with regard to functional treatment (14 h/d prescription), while it was sufficient for retention purposes (8 h/d prescription). Objective measures are necessary to assess compliance with removable orthodontic appliances since patient compliance is a highly variable issue.
Objective:
To assess the effect of wear-time recording on subjective and objective wear time.
Materials and methods:
This study retrospectively examined a group of 18 patients and a control group of 14 patients at four appointments over 168 days. The patients were treated with removable appliances with embedded TheraMon-microsensors to be worn for 15 hours per day. The study group was not told about the microsensor until the first appointment after fitting of the appliance. At each appointment patients were asked about their subjective wear time and afterward were told about the objective wear time. The existence of the microsensor was revealed to the control group when the appliance was fitted. Objective wear time was also announced at every appointment.
Results:
Mean wear times did not significantly differ between groups at any appointment or regarding overall wear time. Highly significant differences between subjective and objective wear time were found when patients did not know that their wear time had been monitored.
Conclusion:
Mean wear times assessed in this study concur with data of previous studies. Patients tend to overestimate their wear times but become more realistic once they know wear time is being monitored. Objective measurement of wear time allows a more realistic view of compliance by patient and orthodontist. Knowing that wear time is recorded does not necessarily increase the amount of time removable appliances are worn by the patient.
Introduction
Patient satisfaction becomes more important in our modern health care system. The assessment of satisfaction is difficult because it is a multifactorial item for which no golden standard exists. One of the potential methods of measuring satisfaction is by using the well-known visual analogue scale (VAS). In this study, we validated VAS for satisfaction.
Patient and methods
In this prospective study, we studied 147 patients (153 hips). The construct validity was measured using the Spearman correlation test that compares the satisfaction VAS with the Harris hip score, pain VAS at rest and during activity, Oxford hip score, Short Form 36 and Western Ontario McMaster Universities Osteoarthritis Index. The reliability was tested using the intra-class coefficient.
Results
The Pearson correlation test showed correlations in the range of 0.40–0.80. The satisfaction VAS had a high correlation between the pain VAS and Oxford hip score, which could mean that pain is one of the most important factors in patient satisfaction. The intra-class coefficient was 0.95.
Conclusions
There is a moderate to mark degree of correlation between the satisfaction VAS and the currently available subjective and objective scoring systems. The intra-class coefficient of 0.95 indicates an excellent test–retest reliability. The VAS satisfaction is a simple instrument to quantify the satisfaction of a patient after total hip arthroplasty. In this study, we showed that the satisfaction VAS has a good validity and reliability.
Retention is routinely prescribed after orthodontic treatment to prevent relapse. Orthodontists often notice a discrepancy between what a patient reports about retainer wear and what a clinical examination shows. In these cases, is the patient misreporting wear, or is the retainer at fault? Scientific Compliance (Atlanta, Ga) has invented, patented, and produced the Smart Retainer environmental microsensor that can be easily incorporated into many types of removable orthodontic appliances to monitor compliance. The technology behind the Smart Retainer environmental microsensor is possible because of recent reductions in electronic component sizes and power requirements. A proprietary USB-powered Smart Reader uses wireless technology to download information about actual usage from the Smart Retainer. The information is decrypted and analyzed, and can be shown to the patient in easy-to-understand charts. The orthodontist can use this information to discuss actual retainer usage vs prescribed retainer usage with the patient or parent and make data-driven recommendations about future retention.
Content analysis is a widely used qualitative research technique. Rather than being a single method, current applications of content analysis show three distinct approaches: conventional, directed, or summative. All three approaches are used to interpret meaning from the content of text data and, hence, adhere to the naturalistic paradigm. The major differences among the approaches are coding schemes, origins of codes, and threats to trustworthiness. In conventional content analysis, coding categories are derived directly from the text data. With a directed approach, analysis starts with a theory or relevant research findings as guidance for initial codes. A summative content analysis involves counting and comparisons, usually of keywords or content, followed by the interpretation of the underlying context. The authors delineate analytic procedures specific to each approach and techniques addressing trustworthiness with hypothetical examples drawn from the area of end-of-life care.
The aim of this systematic review of the literature was to assess the scientific evidence on the efficiency of functional appliances in enhancing mandibular growth in Class II subjects. A literature survey was performed by applying the Medline database (Entrez PubMed). The survey covered the period from January 1966 to January 2005 and used the medical subject headings (MeSH). The following study types that reported data on treatment effects were included: randomized clinical trials (RCTs), and prospective and retrospective longitudinal controlled clinical trials (CCTs) with untreated Class II controls. The search strategy resulted in 704 articles. After selection according to the inclusion/exclusion criteria, 22 articles qualified for the final analysis. Four RCTs and 18 CCTs were retrieved. The quality standards of these investigations ranged from low (3 studies) to medium/high (6 studies). Two-thirds of the samples in the 22 studies reported a clinically significant supplementary elongation in total mandibular length (a change greater than 2.0 mm in the treated group compared with the untreated group) as a result of overall active treatment with functional appliances. The amount of supplementary mandibular growth appears to be significantly larger if the functional treatment is performed at the pubertal peak in skeletal maturation. None of the 4 RCTs reported a clinically significant change in mandibular length induced by functional appliances; 3 of the 4 RCTs treated subjects at a prepubertal stage of skeletal maturity. The Herbst appliance showed the highest coefficient of efficiency (0.28 mm per month) followed by the Twin-block (0.23 mm per month).
Introduction:
The aim of this 2-arm parallel trial was to assess patient compliance objectively with Hawley or vacuum-formed retainers in the maxillary arch in a 3-month period after active orthodontic treatment through the use of the thermosensitive microsensor TheraMon.
Methods:
Patients who had just completed orthodontic treatment in the Postgraduate Orthodontic Clinic, School of Dentistry, National and Kapodistrian University of Athens and in a private orthodontic practice were randomly allocated to either the Hawley or vacuum-formed group for retention. Eligibility criteria included patients aged 12-18 years who had undergone orthodontic treatment in both arches for ≤ 5 years. The main outcome was the average objective daily difference in compliance measured with TheraMon between patients receiving either Hawley or vacuum-formed retainers in the maxillary arch for 3 months. Secondary outcomes pertained to the average objective difference in compliance between the 2 retainers for the first month in retention and the association between objective measurements of compliance and diary-reported duration of wear for both the first and 3- month periods. Randomization was implemented with a computer-generated randomization list; allocation was concealed in sequentially numbered, sealed, opaque envelopes. Blinding to the study protocol was not feasible either for the patient or orthodontist. Patients were instructed to wear the retainer full-time. Data were analyzed using nonparametric statistics and linear regression with standard errors based on the bootstrap method.
Results:
Seventy-seven patients (median age 14.8 years; interquartile range 1.5; range 12.1-17.6) were randomized in a 1:1 ratio to either a Hawley or vacuum-formed retainer. Baseline characteristics did not present significant differences between groups. One patient from the Hawley group was excluded from 3 months' follow-up owing to a microsensor fault. Objectively assessed median daily wear time for the Hawley group was 15.3 hours (interquartile range 6.8), whereas for the vacuum-formed group it was 18.3 hours (interquartile range 4.6) for the 3-month interval. Patients allocated to vacuum-formed retainers had higher wearing values of 2.10 h/d compared with the Hawley group, after adjusting for trial settings (mean difference 2.10; 95% confidence interval 0.32-3.89; P = 0.02). Patients from private orthodontic practice had an increased potential for compliance of 2.16 h/d compared with university settings after adjusting for type of appliance (mean difference 2.16; 95% confidence interval 0.34-3.97; P = 0.02). A significant correlation was detected between objective assessment and self-reported compliance for both retention protocols in the first and 3-month intervals. No harm was observed during follow-up.
Conclusions:
This study found relatively high compliance in the short-term retention phase for both appliances. Vacuum-formed retainers were better accepted by adolescent patients, whereas those proceeding to private orthodontic practice were more compliant. There was a positive and statistically significant correlation between objective and subjective measures of compliance.
Registration:
This trial was registered in ClinicalTrials.gov: NCT03683862.
Funding:
No funding or conflict of interest to be declared.
Protocol:
The protocol was not published before trial commencement.
Introduction:
The aim of this 2-arm parallel study was to compare the dentoalveolar and skeletal changes achieved with Twin-block appliance therapy prescribed on either a part- or full-time basis for 12 months.
Methods:
Sixty-two 10- to 14-year-old patients were randomly allocated to either full-time (FT, 22 hours daily) or part-time (PT, 12 hours daily) wear of a modified Twin-block appliance. Participants were recruited from the Institute of Dentistry, Barts and the London School of Medicine and Dentistry, London, United Kingdom, and recalled at 6- to 8-week intervals. Electronic randomization was undertaken, with group allocation concealed using opaque, sealed envelopes. The outcome assessor was blinded; however, it was not feasible to blind either operator or patients. Study models and cephalograms were taken at baseline and after 12 months of treatment.
Results:
Data from 55 of the 62 participants were analyzed. Overjets were reduced by 7 mm (SD, 2.92) in the PT group and 6.5 mm (SD, 2.62) in the FT group, with no statistical difference between the groups (P = 0.587; 95% CI, -1.01, 1.78). Similarly, no clinical or statistical differences were noted for skeletal changes: ANB angle (PT, -1.51°; FT, -1.25°; P = 0.828; 95% CI, -0.68, 0.849), pogonion-sella vertical (PT, 3.25 mm; FT, 3.35 mm) or A-sella vertical (PT, 1.28 mm; FT, 1.06 mm). Mean wear durations were 8.78 hours a day in the PT group and 12.38 hours in the FT group.
Conclusions:
There was no difference in either dental or skeletal changes achieved with PT or FT wear of a Twin-block appliance over 12 months. Less onerous PT wear regimens may therefore be a viable alternative to FT wear of removable functional appliances.
Registration:
NCT02190630.
Protocol:
The protocol was not published before trial commencement.
Introduction:
Lack of compliance during functional appliance therapy may lead to extended treatment or even induce treatment failure. The aims of this study were to explore factors influencing compliance in adolescents treated with a Twin-block appliance.
Methods:
A qualitative study using one-to-one semistructured interviews involving a sample of adolescents undergoing Twin-block therapy with objectively recorded wear durations was undertaken. A topic guide was used to standardize data collection. Participants' views were tape recorded and field notes taken. Data were transcribed verbatim and analyzed with the use of framework methodology.
Results:
A total of 22 participants were interviewed. Factors influencing compliance with removable functional appliance included: self-motivation, peer and authority influence, quality of life impairment and adaptability, perceived treatment progress, and pragmatic and recall issues. These factors were found to exert important roles as enablers, barriers, or both. Patient recommendations to improve compliance included effective communication, tailoring of prescribed wear duration, physical alteration of the appliance, and use of reminding tools.
Conclusions:
The study highlights the multifaceted perceptions of removable functional appliance wear, with compliance fluctuating over time and a range of factors influencing this. The potential for professional and parental influence as well as customized reminders to enhance compliance were also reported.
Objectives:
To assess patient compliance and treatment efficacy of preventive expansion treatment with removable Planas functional appliances using an integrated microsensor.
Materials and methods:
Wear time (WT) and behavior of 69 patients undergoing treatment with Planas functional appliances were assessed and analysed using TheraMon microsensors (Gschladt, Hargelsberg, Austria). Patients were followed up for a period of 9 months, and visits were made every 3 months to download WT data from the microsensor and to assess wearing behavior. From individual WT graphs,10 parameters were derived to characterize compliance for each patient. Treatment efficacy was measured by eight parameters determining the level of expansion after 9 months of treatment.
Results:
Patients wore their device on average 15.8 ± 5.2 h/d. WT was unrelated to age and gender, but it was positively influenced by patient habits when keeping appliances during eating, sports, care and handling. Treatment efficacy in terms of intercanine and intermolar expansion was 4.4 ± 1.9 mm and 4.6 ± 2.0 mm for the maxilla, and 5.3 ± 2.0 mm and 4.7 ± 2.3 mm for the mandible, respectively. Efficacy was negatively affected by poor compliance (WT < 9 h/d) and by high variability of within-subject WT recordings.
Conclusions:
Perfect compliance is not necessary to achieve treatment success, but patients should exhibit sufficient wear time to allow maxillary expansion to occur. The TheraMon microsensor offers a new perspective and aid to individualize treatment prescriptions.
Introduction
The aim of this study was to use a microsensor to investigate the association among overjet reduction, treatment duration, and wear time of the van Beek activator.
Methods
The study sample comprised patients (n = 28) with a mean age of 11.60 (±1.25) years at start of treatment treated with the van Beek activator. The prescribed wear time was 12 hours per day. The evaluation period was limited to the first 3 appointments. The wear times during the 3 intervals were assessed. Treatment periods with good compliance were characterized by a wear time of 8 hours or more per day.
Results
The medians of overjet were 9.00 mm at the start of treatment and 5.75 mm at the third appointment. The mean total wear time throughout the evaluation period was 7.75 (±3.66) hours per day. Significant correlations were found at the 3 intervals. Patients with a mean wear time of 8 hours or more per day achieved significantly greater overjet reductions. Patients with good compliance of at least 5 months showed significantly greater overjet reductions.
Conclusions
Significant overjet reduction was achieved with a minimum daily wear time of 8 hours for at least 5 months. The level of compliance had a strong tendency to be maintained throughout the treatment period. No patient achieved the prescribed wear time of 12 hour per day.
The aim of this study was to evaluate the compliance and short-term effects of eruption guidance appliance (EGA) in adolescents with class II division 1 malocclusion in comparison with twin-block appliance (TBA) and activator-headgear appliance (A-HG). Dental records of 1886 patients were viewed in this retrospective study 129 patients treated with one of these three functional appliances were identified. 123 fulfilled the inclusion criteria and data were extracted from the dental records. Gender, age, compliance, overjet change at every visit, number of appliance breakages and number of emergency visits apart from appliance breakage were studied. The data were analyzed with Chi-square test, General Linear Model and Fisher scoring test. Results showed that 47 patients were treated with EGA, 38 patients with TBA and 38 patients with A-HG. Mean ages starting the treatment were slightly lower with EGA (11.5 years) than with TBA (12.3 years) and A-HG (11.8 years). Non-compliance was higher in the EGA group (31.9%) than TBA group (26.3%) and A-HG group (23.7%). Mean overjet reduction per month was 0.6 mm for EGA which was lower than TBA group (0.7 mm) and A-HG groups (0.7 mm).The number of emergency visits and appliance breakage were lower in EGA group. However, there was no statistically significant difference between the 3 groups regarding ages,compliance, mean overjet reduction, emergency visits and appliance breakage aspects. In conclusion, this study indicates that EGA is an alternative choice in the treatment of adolescent patients with class II division 1 malocclusion. However, long-term follow-up and cephalometric prospective study should be performed to continue our understanding more about the mechanisms of EGA and more definite conclusions can be made.
Background/objectives:
Facial soft tissues changes during growth roughly tend to mimic the underlying hard tissues, but not completely. The aim of this mixed longitudinal study was to assess facial growth among pre-pubertal and pubertal subjects without malocclusion using a non-invasive three-dimensional laser scanning system.
Subjects/methods:
Fifty-nine subjects (30 females and 29 males) aged at baseline 5.4-8.9 years with normal occlusion were clustered into the younger, older pre-pubertal, and pubertal groups according to age and the absence/presence of a standing height growth spurt. Three-dimensional facial images were obtained using laser scanners for five consecutive years. Several transversal, sagittal, and vertical parameters were assessed for between and within group comparisons.
Results:
Significant overall changes of almost all parameters were seen within each group (P < 0.05) without any group differences (P > 0.05). The younger pre-pubertal group showed greater annual growth rates of lip prominence; both pre-pubertal groups showed greater rates in facial middle third height. The pubertal group showed greater annual rates in facial profile angle changes during the growth peak.
Limitations:
A high standing height increment (7cm) was used as the threshold for subject allocation in the pubertal group.
Conclusions:
Soft tissue facial growth has generally similar amounts and rates irrespective of the pubertal growth spurt. Pre-pubertal subjects show greater annual rates of facial middle third height changes while pubertal subjects show greater annual rates of chin protrusion.
Esthetics and Biomechanics in Orthodontics, 2nd Edition provides everything you need to know to successfully apply biomechanics in clinical orthodontics. This edition features new content in the areas of tooth movement, treating Class III malocclusions, skeletal anchorage, Surgery First treatment plans, and space closure. In addition to comprehensive guidance on basic biomechanic principles, this state-of-the-art reference also shows how all techniques can apply biomechanical principles to improve the force delivery, understand and prevent side effects, and achieve predictable results.
Introduction: The aim of this study was to investigate whether microelectronic wear-time documentation can contribute to individualized orthodontic management. Methods: The wear times and behaviors of 281 patients undergoing orthodontic treatment with removable appliances were quantified and analyzed using the TheraMon microelectronic system (Sales Agency Gschladt, Hargelsberg, Austria) over a 6-month treatment period. Results: The 281 study participants wore their removable appliances for a median of 9.0 hours per day, compared with the 12 to 15 hours per day prescribed. Wear behavior was variable and heterogeneous in patients with almost identical median wear times, with fluctuating and numerous zero wear-time periods observed. Conclusions: Both the duration of daily wear time and the wear behavior need to be considered to individualize the prescription for wear time; this is made possible with microelectronic wear-time documentation. Individual prescription changes based on the wear-time documentation can be arranged with patients in a shared decision-making process to achieve effective and successful treatment progress. (Am J Orthod Dentofacial Orthop 2014;146:155-60) I ndication-dependent removable appliances, fixed appliances, and combinations of both are used in or-thodontic treatment. In Europe, the less expensive and less invasive removable appliances are commonly used for orthodontic treatment, mainly in the first phase of 2-phase active treatment but also during the reten-tion phase. 1-3 In the United States, fixed multibracket appliances are largely preferred for the active phase. Removable devices, such as the Hawley retainer (used by 58% of American orthodontists), are used first in the subsequent retention phase. 4,5
Objectives:
The aim of this study was to quantify the wear times of removable appliances during active orthodontic treatment.
Materials and methods:
The wear times of 141 orthodontic patients treated with active removable appliances in different locations were documented over a period of 3 months using an incorporated microsensor. Gender, age, treatment location, health insurance status, and type of device were evaluated with respect to wear time. Significant associations between wear times and patient factors were calculated using non-parametric tests.
Results:
The median daily wear time was 9.7 hours/day for the entire cohort, far less than the 15 hours/day prescribed. Younger patients wore their appliances for longer than older patients (7-9 years 12.1 hours/day, 10-12 years 9.8 hours/day, and 13-15 years 8.5 hours/day; P < 0.0001). The median wear time for females (10.6 hours/day) was 1.4 hours/day longer than males (9.3 hours/day; P = 0.017). Patients treated at different locations wore their devices with a difference of up to 5.0 hours/day. Privately insured patients had significantly longer median wear times than statutorily insured patients. No significant difference in wear time was noted according to device type.
Conclusions:
The daily wear time of removable appliances during the active phase of orthodontic therapy can be routinely quantified using integrated microelectronic sensors. The relationship between orthodontist and patient seems to play a key role in patient adherence. Wear-time documentation provides the basis for more individualized wear-time recommendations for patients with removable appliances. This could result in a more efficient, shorter, and less painful orthodontic therapy.
identify and describe the major design issues in the planning stage of a [funded] qualitative project / suggest practical ways for the researcher to overcome the paradoxes inherent in qualitative inquiry / provide a guide to the planning of qualitative proposals and include suggestions for avoiding the pitfalls inherent in the research process
begin with the stage of reflection, in which the project is merely a good idea, and proceed to the stage of planning (including writing the proposal) and the stage of entry or beginning the fieldwork / when data collection is going well and is fruitful, the researcher enters the stage of productive data collection / next is the stage of withdrawal, which is followed by the . . . stage of writing (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In the first phase of a randomized clinical trial of early versus late Class II treatment, statistically significant differences were observed between the treatment and observation groups. However, there were wide variations in response. The change in jaw relationship (categorized as the annualized reduction in ANB angle) was favorable or highly favorable in 76% of the headgear, 83% of the functional appliance, and 31% of control (observation only) groups. The patient's initial skeletal severity, age/maturity at the outset of treatment, growth pattern, and cooperation with treatment were examined as possible influences on early growth modification treatment. Correlations between the annualized change in the ANB angle and any of the possible influences were close to zero and not statistically significant. We conclude that there is little to be gained from precisely timing early treatment to specific age/maturity markers and that a favorable reduction in Class II skeletal problems can occur for patients in a broad range of skeletal severity and growth patterns. Cooperation, measured as the number of hours of reported wear, or the clinical assessment of compliance, explained little of the variation in treatment response. The wide variation in growth seen in the untreated patients highlights the importance of well-controlled studies if clinicians are to improve their ability to select children with the greatest chances of a favorable treatment response. (Am J Orthod Dentofac Orthop 1997;111:533-42.)
To investigate the interrelationships between factors involved in orthodontic treatment seeking by children aged 12-15 years.
State funded orthodontic clinic at the Faculty of Dentistry of the Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil, and a nearby public school.
One hundred and ninety-four adolescents aged 12-15 years took part in the study; 92 had sought orthodontic treatment at UERJ (orthodontic group) and 102 were from a nearby public school and had never undergone or sought orthodontic treatment (comparison group). Each participant underwent a comprehensive oral examination, and both parent and child were questioned about who had initiated the orthodontic referral.
Normative need assessed with IOTN DHC; clinician and self-perceived aesthetic perception assessed with IOTN AC, previous caries experience was determined using the decayed, missing and filled teeth index (DMFT) and WHO diagnostic criteria. The 'Brazil Economic Classification Criteria' was used to classify the socioeconomic status. Intra-examiner repeatability and inter-examiner agreement were assessed with kappa statistics. Univariate and multiple logistic regression analyses were used to investigate the association between orthodontic treatment seeking (dependent variable) and the independent variables (i.e. aesthetic impairment, malocclusion severity, socioeconomic status, gender, age and DMFT).
Univariate analyses showed that self-perceived aesthetics (P<0.001), examiner-assessed aesthetics (P = 0.01) and treatment need (P<0.001), socioeconomic status (P<0.001) were significantly associated with orthodontic treatment seeking, but gender (P = 0.22) and DMFT (P = 0.41) were not. Multiple logistic regression analyses showed that poor self-perceived aesthetics (OR = 16.7; 95% CI: 4.17-61.9), more severe malocclusion (OR = 3.4; 95% CI 1.64-7.14) and better socioeconomic position (OR = 39.1; 95% CI: 5.47-280.54) significantly influenced the decision to seek orthodontic treatment.
Concern about dental appearance and the desire for treatment, together with normative orthodontic need, should be carefully assessed by dentists before referring patients to specialized orthodontic care in publicly-funded clinics. In a publicly-funded oral health care system, self-perceived orthodontic treatment need is the key to establishing treatment priority.
Orthodontic patients' cooperation determines their treatment outcomes. Our objectives were to compare orthodontic treatment motivation of child and adolescent patients and their parents at an initial screening appointment with the responses of patients in treatment and their parents. Furthermore, we explored the association between participants' levels of treatment motivation and treatment cooperation.
Data were collected from 227 child and adolescent patients (50.2% boys, 49.8% girls; average age, 13 years; age range, 7.11-16.11 years) and their parents. Of the respondents, 144 (63.4%) were in orthodontic treatment (71 boys, 73 girls), and 83 (36.6%) (43 boys, 40 girls) were surveyed at their initial orthodontic screening appointment.
Parents reported greater motivation for their children to have orthodontic treatment than did the children. This was especially true among patients who were already in treatment. The higher the patients' treatment motivation, the more they reported that they cooperated with their orthodontists' treatment recommendations. However, the parents' motivation for their child to have orthodontic treatment was not significantly correlated with their children's treatment cooperation.
Although parents reported greater motivation levels than their children, the patients' levels of motivation to receive orthodontic treatment were found to determine their reported cooperation with their orthodontists' treatment recommendations.
A cephalometric analysis especially designed for the patient who requires maxillofacial surgery was developed to use landmarks and measurements that can be altered by common surgical procedures. Because measurements are primarily linear, they may be readily applied to prediction overlays and study cast mountings and may serve as a basis for the evaluation of posttreatment stability.
The occurrence of malocclusions and the need for orthodontic treatment were studied in 1200 9 year old children. Various parameters of anomalies and the grading of the need for treatment were recorded according to Scandinavian criteria with some minor modifications. Occlusal, space and dental anomalies were found in 60.2% of the cases, crowding being the most common finding (25.9%). Postnormal occlusion (Class II) was recorded in 15.0% of the cases, but prenormal occlusion (Class III) in only 0.8%. A 5 grade scale was used to estimate the need for orthodontic treatment. One of four children had either a very urgent need (12.3%) or an urgent need (13.3%) for treatment. The somewhat simplified method for estimating malocclusions and the need for treatment proved to be rapid. An orthodontist assisted by two nurses performed the examination in 2 minutes per child. An additional 1-2 minutes must be added to this time for preparative work and drawing conclusions.
Cephalometric radiographs were taken before and after treatment in three groups of patients. Ten were treated with removable appliance therapy involving extraction of upper first premolars and retraction of anterior teeth. Ten were treated on a non extraction basis coupled with wearing an upper expansion appliance followed by an Andresen appliance. Another group of ten patients were treated in an identical manner except that they wore a Twin Block instead of the Andresen appliance. When comparing the patient groups before and after treatment, statistically significant differences were found for upper incisor angulation in the Removable (t = 9.49 p < 0.001) Andresen (t = 4.48 p < 0.001) Twin Block (t = 2.81 p < 0.001) groups and for angle ANB in the Andresen (t = 2.88 p < 0.01) and Twin Block (t = 2.65 p < 0.01) groups. Thus the overjet was reduced purely by incisor tipping with the removable appliance as would be expected, but both functional appliances produced some bodily correction with an improvement in the dental base relationship. Although the Twin Block appliance group showed a greater reduction in angle ANB this was not significantly different from that in the Andresen appliance group. The treatment time from insertion of the first appliance to reduction of the overjet to 3mm or less was also recorded. The treatment time for the Twin Block group (8.1 months) was significantly less (t = 2.79 p < 0.05) than the Andresen group (12.8 months), but neither functional group differed significantly from the removable appliance group (10.1 months).
A simplified and relevant cephalometric soft tissue analysis has been developed that is applicable to planning treatment for patients requiring orthognathic surgery. Standards are presented that describe young adult Caucasians. If facial improvement is one of the major objectives of surgical procedures, it is necessary that soft tissue be measured directly. Variations in the soft tissue covering the face can produce misleading conclusions if diagnosis and planning are based on dental and skeletal measurements alone. Treatment using hard tissue cephalometric standards may not lead to the desired improvement in facial form. The soft tissue analysis evaluates both vertical and horizontal aspects of the face, including lip length and posture. The measurement of the interlabial gap brings in a functional parameter in addition to morphologic considerations. If a prime objective of orthognathic surgery is facial improvement, soft tissue analysis becomes paramount in treatment planning.
This study analyzed the occlusions of 489 children at the onset of the mixed dentition period (mean age 5.1 years, range 4.0-7.8 years). These children participate in an ongoing clinical trial that is investigating the effects of orthodontic intervention in the early mixed dentition. The aim was to report the occlusal findings at the baseline. The frequencies of mesial step, flush terminal plane, and distal step were 19.1%, 47.8%, and 33.1%, respectively. The canine relationship was Class I in 46.1%, Class II in 52.4%, and Class III in 1.5% of the sides examined. An asymmetrical canine relationship was found in 30.1% of the children, significantly more often on the right side than on the left (P <.001). Overjet ranged from -2 to +10 mm with a mean of 2.9 mm. Overbite ranged from -5 to +8 mm with a mean of 2.8 mm. Excessive (> or =4 mm) overjet was found in 26.7% and overbite in 33.8% of the children; in 15.5% of the children, both variables were 4 mm or more. Anterior crowding was detected in the maxillary arch in 11.6% and in the mandibular arch in 38.9% of the children. Girls showed mandibular crowding more often than boys (P <.01). A posterior crossbite was found in 7.5% of the children, unilaterally in 6.4% and bilaterally in 1.1%. Scissors-bite was detected in 1.1% and an anterior crossbite in 2.2% of the children. The mean maximal opening was 40.3 mm. Joint sounds were registered in 5.2% of the children. The prevalence of malocclusion was between 67.7% and 92.7%, depending on the values of unacceptable parameters used for each occlusal characteristic.
Cephalometrics for orthognathic surgery
- Burstone