Ahmad Abdelkarim

Craniofacial polyostotic fibrous dysplasia: a case report and review of the literature

Craniofacial fibrous dysplasia is 1 of 3 types of fibrous dysplasia that can affect the bones of the craniofacial complex, including the mandible and maxilla. A 49-year-old white male presented with an extensive previous medical history. Initial radiographic assessment comprised panoramic and PA cephalometric radiographs and provided a working diagnosis of fibrous dysplasia. Advanced imaging included conventional CT, cone beam CT, and MRI. Three areas in the craniofacial complex were diagnosed as FD. The patient also presented with severe degenerative joint disease of the left TMJ. In this case, all FD lesions were radiopaque and presented with ground glass appearance. The relative importance of each imaging modality in the diagnosis and assessment of FD is discussed.

Risk management strategies in orthodontics. Part 2: Administrative considerations

Orthodontic practice results in relatively few patient challenges and litigations. This often leads to a false sense of security and encourages orthodontists to optimize practice management techniques that may be at odds with risk management considerations. Examples include excessive duty delegation to dental auxiliaries, office designs that invade patient privacy, and 1-visit consultations that have the potential to compromise the diagnosis and treatment planning process. Practitioners need to consciously balance risk management techniques against practice management initiatives. The strategies and opinions expressed do not necessarily represent the opinions of the American Journal of Orthodontics and Dentofacial Orthopedics, the American Association of Orthodontists, the American Board of Orthodontics, or the College of Diplomates of the American Board of Orthodontics.

Effect of JPEG2000 compression on landmark identification of lateral cephalometric digital radiographs

INTRODUCTION As digital imaging improves and digital cephalometric radiography becomes more prevalent, the need for digital storage space and transmission speed will increase. Compression of the image files is 1 method to overcome transmission overload. However, compression could compromise image quality. The purpose of this study was to determine the range of compression ratios, by using the JPEG2000 standard, within which the identification of landmarks on cephalometric radiographs is not compromised. METHODS Ten lateral cephalometric digital images were used. Six raters identified 19 landmarks under controlled viewing conditions. The images included the original uncompressed TIFF image and the JPEG2000 format at 3:1, 12:1, 50:1, and 110:1 compression ratios. The images were randomized and displayed with image processing software. The x and y coordinates of each landmark were recorded. RESULTS All compression ratios performed equally well compared with the original images with the exception of A-point and nasion at 110:1 and gonion at 3:1 compression ratios. All landmark identifications were precise with the exception of the maxillary incisal apex and edge at the 12:1 and 50:1 compression ratios, respectively. CONCLUSIONS JPEG2000 is a reliable file format that can be implemented in orthodontic practice.

Proposed AJO-DO Resource Center on cone-beam computed tomography imaging

As more of us get used to going online to find new information, it becomes almost routine to look for “Cochrane.org” as one of our best sources of available evidence in both medicine and dentistry. Archie Cochrane (1909-1988) was an amazing man, and I encourage you to read of his impact on the development of epidemiology as described in an editorial by Vincent G. Kokich (Am J Orthod Dentofacial Orthop 2013;144:1). Cochranes influence on the importance of credible research methods lived on after his death and led to the opening of the first Cochrane Center at Oxford in 1992 and the founding of the Cochrane Collaboration a year later. Its one thing for you as an orthodontist to know where to find the latest Cochrane systematic reviews, but I have yet to hear any patients of mine mention anything about finding that site to answer their questions. Oh yes, they are quick to mention Wikipedia and Google, but how well screened are those levels of evidence when it concerns the details of todays orthodontic care? Fortunately, our publisher, Elsevier, is very aware of the need to make it easier for our patients as well as our ownmembers to find the best information regarding the progress being made by our specialty. To help make this happen, Elsevier is working with us to establish an AJO-DO Resource Center. The first topic to be addressed will be cone-beam computed tomography (CBCT) imaging. Once established, other topics of interest could be added, as they have in other health care organizations. Why start with CBCT? It is a revolutionary imaging technique that has added significant value to dentistry. Patients with specific orthodontic needs—eg, impacted teeth or narrowed pharyngeal airway—benefit from 3dimensional imaging. Unlike traditional 2-dimensional

Orthodontic chart documentation

Comprehensive records for orthodontic patients should include diagnosis, problem list, treatment objectives, treatment plan, treatment alternatives, normal and abnormal clinical findings, description of the treatment rendered, any referrals made, follow-up treatment, and recommendations, as well as documentation of all consultations, financial agreements, and insurance forms. The purposes of the patients clinical chart are to maintain continuity of care, register procedures performed in anorderedmanner, remind the doctor of whatwas done and what needs to be done, and justify and support the medical necessity of the treatment provided to appropriate parties of interest. Appropriate documentation also includes communications between the orthodontist and other health professionals who are contributing to the patients care; thus, the dental record also protects the overall legal interest of all interested parties. Quality orthodontic chart documentation can indicate quality care. Excellent documentation speaks volumes about the orthodontists competence and organization, which in turn increase credibility. Laypeople are not expected to document treatment, but an orthodontist is expected to keep permanent records of what acts and activities transpired during doctor-patient encounters. In addition to documenting the diagnosis, treatment plan, mechanotherapy, archwires, and elastometrics, there are several strategies on what else to document and what not to. The following strategies are presented to help the orthodontic community more accurately reflect the patients orthodontic care, whether this documentation is in paper or electronic format. These guidelines should be modified as needed for each practitioner and patient.

Strategies for improved interdisciplinary care and communication in orthodontics

Interdisciplinary care and communications with other doctors require meticulous management. It is frequently difficult to oversee a collaborating doctors work, thoughts, and risk management practices. Professionals from different disciplines often provide care at different times and locations, limiting synchronous interaction. Therefore, there could be an increased potential for liability and injury when working with other health care providers. Although an orthodontist is liable for only the services that he or she provides, the scope of the services in question can be difficult to defend if problems arise. In addition, the provision of interdisciplinary care can be highly complex and costly for the patient, often contributing to rising expectations on the patients part. To improve patient care and minimize exposure to liability in interdisciplinary care, the following risk management strategies can be followed and modified as needed.

An in vivo study on the incidence and location of fracture in round orthodontic archwires

Objective The main objective of this in vivo study was to determine the incidence and location of fracture in round nickel–titanium (NiTi) and round stainless steel orthodontic archwires, both commonly used in orthodontics. Secondarily, this study sought to determine if there is any correlation between archwire fracture and gender, diameter of the archwire, arch type (maxillary/mandibular) or bracket used. Design In vivo study. Materials and methods One thousand orthodontic patients (1434 archwires) were evaluated during regular treatment visits to assess archwire fracture and location. The patients gender, age, type of archwire (round NiTi and round stainless steel), diameter of the archwire, arch type, location of fracture (anterior or posterior) and period of service before fracture were recorded. Statistical analysis Chi-square statistical test was utilized to address the frequency and the correlation between the different variables. Level of statistical significance (α) was set at 0.05. Results Twenty-five archwire failures were reported (1.7%) of the total sample size. All fractured archwires were NiTi, and 76% of the fractures were located in the posterior region. No statistical significance was found between archwire fracture and gender, arch type (maxillary/mandibular), archwire diameter or bracket type. Conclusion The frequency of archwire fracture during regular orthodontic visits is very low. The most common archwire fracture site is the posterior region. NiTi wires are the most commonly fractured archwire. No statistically significant correlation exists between archwire fracture and gender, arch type, bracket type or diameter of archwire.