Bhavna Shroff

Segmented approach to simultaneous intrusion and space closure: Biomechanics of the three-piece base arch appliance

Deep overbite correction and space closure in patients with flared incisors are mechanically difficult to achieve with conventional orthodontic treatment. The purpose of this article is to present an appliance design that allows simultaneous intrusion and retraction of anterior teeth as well as correction of their axial inclinations. A three-piece base arch was used to achieve simultaneous intrusion and space closure. Various clinical situations are discussed and analyzed from a biomechanical standpoint. Sequences of treatment, appliance design, and management of side effects are described in detail. The segmented approach to simultaneous intrusion and space closure is useful for achieving precise control of tooth movements in the anteroposterior and vertical dimensions.

Development of white spot lesions during orthodontic treatment: Perceptions of patients, parents, orthodontists, and general dentists

INTRODUCTION Despite the many advances to improve the practice of orthodontics, white spot lesions, or decalcifications, remain a common complication in patients with poor oral hygiene. The purpose of this study was to assess the perceptions and level of awareness of patients, parents, orthodontists, and general dentists toward the development of white spot lesions during orthodontic treatment. METHODS This was a prospective epidemiologic survey of the perceptions of orthodontic patients (n = 315), parents (n = 279), orthodontists (n = 305), and general dentists (n = 191) regarding the significance, prevention, and treatment of white spot lesions. RESULTS All surveyed groups indicated that white spot lesions detracted from the overall appearance of straight teeth, attributed primary responsibility for the prevention of white spot lesions to the patients themselves, and thought that the general dentist should be responsible for treating white spot lesions. Patients regarded themselves as ultimately responsible for the prevention of white spot lesions (P <0.05). CONCLUSIONS The patients, parents, orthodontists, and general dentists had similar perceptions regarding the significance, prevention, and treatment of white spot lesions. All groups indicated that patients were the most responsible for the prevention of white spot lesions. Communication among patients, parents, orthodontists, and general dentists needs to improve to decrease the incidence of white spot lesions in the orthodontic population.

Effect of pumice prophylaxis on the bond strength of orthodontic brackets

Pumice prophylaxis has long been accepted as a prerequisite for achieving adequate enamel etching during orthodontic bonding procedures. Three methods were used in this study to examine the effects of pumice prophylaxis on the bond strength of orthodontic brackets: (1) shear bond strength of brackets that were bonded to extracted premolars after surface preparation procedures, which either included or did not include prior pumice prophylaxis, was evaluated; (2) scanning electron microscopy (SEM) was used to examine the surface characteristics of teeth that had been etched with and without prior pumice prophylaxis; and (3) rate of bracket failure in patients who had had brackets bonded with and without prior pumice prophylaxis was recorded during an average treatment time of 18 months. No significant differences were noted in bond strength, general etched enamel surface characteristics, or bracket retention rates. Some specific differences, however, were noted on SEM in localized areas of the etched enamel surfaces, although these did not appear to affect the bond strength or bracket retention rates ultimately attained.

Simultaneous intrusion and retraction using a three-piece base arch.

Flared incisors and deep overbite are challenging to treat orthodontically. This paper describes the use of a three-piece base arch and Class I elastics to correct deep overbite while simultaneously closing spaces. An analysis of the biomechanics and a discussion of the appliance design are presented to help understand how the incisor axial inclination can be corrected and controlled during orthodontic therapy. A clinical example illustrates the treatment sequence.

Importance of pumice prophylaxis for bonding with self-etch primer

INTRODUCTION Self-etching primers (SEP) have simplified the orthodontic bonding process, but questions have arisen regarding their reliability and efficiency. The goal of this study was to assess the importance of a pumice prophylaxis before bonding in reducing bond failures. METHODS Thirty orthodontic patients volunteered to participate in this prospective clinical trial. A split-mouth design was used; in each patient, 1 quadrant was randomly assigned to the pumice prophylaxis experimental group and the contralateral quadrant to the nonpumice group. A total of 508 teeth were bonded with SEP (Transbond Plus; 3M Unitek, Monrovia, Calif) and monitored for 3 months for bond failures. RESULTS Thirty-five failures (6.9%) were recorded, with 6 (2.4%) in the pumice group and 29 (11.4%) in the nonpumice group. Chi-square analysis was used to compare bond failures as a total number between groups and also as the number of patients who experienced bond failures with each method. Statistically significant differences were found both in the total number of bond failures (P <.001) and in the number of patients with bond failures between groups (P <.01). A significantly lower and clinically acceptable bond failure rate was demonstrated with Transbond Plus SEP after pumice prophylaxis. CONCLUSIONS This study produced strong evidence suggesting the need for pumice prophylaxis when using SEP for orthodontic bonding.

Influence of active reminders on oral hygiene compliance in orthodontic patients

OBJECTIVE To determine if text message reminders regarding oral hygiene compliance have an influence on the level of compliance within an orthodontic population. MATERIALS AND METHODS In this prospective, randomized, controlled clinical trial, 42 orthodontic patients were assigned to a text message or control group. Parents of patients assigned to the text message group received a reminder text message one weekday each week. Oral hygiene compliance was measured using bleeding index (BI), modified gingival index (MGI), and plaque index (PI), and visual examination of white spot lesion (WSL) development at baseline (T0), two appointments after baseline (T1), and four appointments after baseline (T2). RESULTS BI, MGI, and PI scores were significantly lower in the text message group than in the control group at T2. CONCLUSION A text message reminder system is effective for improving oral hygiene compliance in orthodontic patients.

Media Advertising Effects on Consumer Perception of Orthodontic Treatment Quality

OBJECTIVE To determine the effect of media advertising on consumer perception of orthodontic treatment quality. MATERIALS AND METHODS A survey instrument was designed to evaluate factors influencing consumer selection of an orthodontist and consumer perception of different forms of media advertising (radio, television, newspaper, magazine, direct mail, and billboard) by orthodontic practices. The surveys were distributed by eight orthodontic offices in and around the Richmond, Virginia area. The survey return rate was 97%. RESULTS Respondents most often cited dentist and patient referrals as how they learned of the orthodontic practices they visited (50% to 57%). A caring attitude and good practitioner reputation were the top reasons influencing actual selection of an orthodontist (53% and 49%, respectively). Of respondents, 14% to 24% felt that advertising orthodontists would offer a lower quality of care than nonadvertising orthodontists. Newspaper, magazine, and direct mail advertisements were viewed more favorably than radio, television, and billboard advertisements. Chi-square analyses revealed few statistically significant differences in perception between different income and education groups. CONCLUSIONS The majority of patients do not perceive advertising to reflect poorly on the quality of orthodontic care. However, patients with different income and education levels perceive media advertising differently.

Interproximal reduction of teeth: Differences in perspective between orthodontists and dentists

OBJECTIVE To determine if interproximal reduction of teeth (IPR) is perceived differently by orthodontists and general dentists. MATERIALS AND METHODS A Web-based survey containing statements about IPR was developed and randomly distributed to orthodontists and general dentists. RESULTS The majority of orthodontists and general dentists strongly agreed that IPR is a minimally invasive procedure that poses little risk for the development of interproximal decay. However, general dentists were more likely to perform post-IPR polishing and to apply topical fluoride than are orthodontists (P < .0001). A greater percentage of orthodontists strongly believed that the esthetic and occlusal benefits of IPR outweigh the potential risk of tooth decay when IPR was performed (P < .0001). A greater percentage of general dentists were hesitant to perform IPR, despite research supporting that IPR has little negative effect on the health of teeth. CONCLUSIONS The results of this study disproved the null hypothesis that orthodontists and general dentists share similar views regarding the use of IPR during orthodontic treatment. General dentists were more conservative in their views of IPR and were less comfortable with performing IPR as a routine procedure. General dentists felt more strongly about the importance of post-IPR polishing and application of topical fluoride. Orthodontists were more likely to have researched the long-term effects of IPR on the health of teeth and therefore felt more comfortable performing IPR during orthodontic treatment.

Orthodontic marketing through social media networks: The patient and practitioner's perspective

OBJECTIVE To (1) assess orthodontic patient and practitioner use of and preferences for social media and (2) investigate the potential benefit of social media in marketing and communication strategies in orthodontic practices. MATERIALS AND METHODS A survey was developed and randomly distributed to orthodontists via the American Association of Orthodontists and to patients/parents via private practices throughout the United States. Participants were asked to answer questions related to their use of social media and their perceptions of the use of social media in the orthodontic practice. RESULTS Of the participants, 76% of orthodontists and 89% of patients/parents use social media. Furthermore, Facebook was the social media platform that was most preferred. Social media use was more common in female and younger adult participants. Orthodontists posted information more often in the morning (40%) and afternoon (56%), and patients/parents used social media mainly in the evening (76%). The most commonly used marketing strategies in the orthodontic practices were social media (76%) and a practice website (59%). Social media and practice websites were positively related with new patient starts (P  =  .0376, P  =  .0035, respectively). CONCLUSIONS Most orthodontists and patients/parents used social media. Social media may be an effective marketing and communication tool in an orthodontic practice.

Influence of Patient Financial Account Status on Orthodontic Appointment Attendance

OBJECTIVE To test the null hypothesis that the financial status of a patients orthodontic contract and other patient and appointment characteristics have no influence on appointment attendance. MATERIALS AND METHODS During a 6-week period, the last appointment of each active, non-Medicaid patient (n = 538) was recorded as either kept or missed. The financial status of the patients contract, age, sex, method by which the appointment was made, and the type of appointment scheduled were recorded. Associations between each of these factors and appointment attendance were evaluated using chi(2) analysis. In the case of patients who missed their appointment, attendance at the subsequent reappointment was also evaluated. RESULTS The overall appointment failure rate was 12.3%. Males (16.2%) were significantly more likely than females (9.5%) to miss appointments (P = .02). Also, appointments made by postcard (28.2%) were more likely to be missed than those made in person (11.8%) or by phone (6.5%) (P = .003). The most significant factor affecting appointment attendance was the patients financial status (P = .0001). Patients with accounts that were overdue (33.3%) or in collections (28.6%) were more likely to miss appointments than those whose accounts were current (10.5%). Of patients who missed their appointment (n = 66), 30% also missed the subsequent reappointment. CONCLUSIONS The null hypothesis was rejected. Patients with delinquent financial accounts were three times as likely to miss an orthodontic appointment as those whose contracts were current. Increased rates of missed orthodontic appointments were also found for males, patients scheduled by mailing a postcard, and patients who had missed their previous appointment.