David L. Turpin

Stability of mandibular lengthening using bicortical screw fixation

The mandibular lengthening procedure performed with the use of rigid internal fixation yields more stable results than previously demonstrated when nonrigid fixation is used. Twenty patients with Class II malocclusion who had undergone this procedure were examined retrospectively to assess postoperative skeletal change. The mean postoperative interval was 15.7 months. Although there was individual variability, no significant mean postoperative horizontal change was found, which indicated excellent stability.

Classification and treatment of Class II subdivision malocclusions.

INTRODUCTIONnPatients with Class II subdivision malocclusions are a challenge for clinicians because reestablishing symmetry in 1 arch or both arches is often a treatment goal. In patients with mandibular skeletal asymmetry, surgery is often a treatment option. However, patients may be unwilling to undergo surgery, and other options might have to be considered. The aim of this study was to evaluate the etiologies and outcomes of Class II subdivision patients treated at the University of Washington graduate orthodontic clinic in Seattle from 1995 throughxa02011.nnnMETHODSnA search of patients treated between 1995 and 2011 resulted in the identification of 110 consecutively treated Class II subdivision subjects with complete records. Ninety-eight subjects could be classified into 1 of 3 groups, based on midline position and dental or skeletal etiology. Initial and final models were used to measure the peer assessment rating scores, midlines, overjet, overbite, and molar positions. Initial and final cephalograms were traced and measured. Charts were reviewed for information regarding treatment.nnnRESULTSnTwenty-five percent of the 98 subjects had their maxillary and mandibular midlines coincident with the facial midline; their asymmetries were due to a maxillary posterior dental asymmetry. Another 15% had maxillary midlines deviated from their facial midlines, caused by maxillary anterior and posterior dental asymmetry. About 50% of the subjects had mandibular midlines that were not coincident with their facial midlines, and most of them exhibited some degree of mandibular skeletal asymmetry. Over the past 15 years, treatment strategies used at the University of Washington indicated trends toward less surgery, fewer extractions, less use of headgear, and more reliance on fixed functional appliances. Ideal correction of midlines was not always achieved, especially in patients with mandibular skeletal asymmetry, with undercorrection occurring more commonly than overcorrection. Final peer assessment rating scores were comparable, regardless of the origin of the asymmetry or the extractions status. Mandibular incisor proclination was increased when fixed functional appliances were used, as well as when a Class I molar relationship was the target for the Class II side.nnnCONCLUSIONSnClass II subdivision malocclusions were grouped into 3 main categories; the largest category was mandibular asymmetry. Interesting trends were noted with regard to treatment strategies, midline and molar corrections, and mandibular incisor proclination.

Why do you want your child to have braces? Investigating the motivations of Hispanic/Latino and white parents.

INTRODUCTIONnMany psychological, social, and cultural factors influence parents motivation to seek orthodontic care for their children. In this study, we used Q methodology to identify and categorize shared motives and determine whether cultural differences exist between Hispanic/Latino (H/L) and non-Hispanic/Latino, white (W) parents.nnnMETHODSnThe fundamental question posed to the parents was Why do you want your child to have braces? Q methodology involves 3 stages. (1) Interviews of H/L (n = 5) and W (n = 5) parents generated 35 statements that represented different motives to seek orthodontic care. (2) In the Q sort, 70 new parents (22 H/L, 48 W) ranked statements in order of relative importance using a forced distribution grid. (3) Factor analysis was performed separately for the H/L and W groups to uncover cultural differences.nnnRESULTSnFour motivational profiles were described for both the H/L and W parents based on the significant factors identified in each group. More H/L parents (18 of 22 parents) than W parents (22 of 48 parents) were characterized by 1 of their groups 4 profiles. Comparisons of the motivational profiles across the groups showed 4 global themes: well-timed treatment that prevents future dental problems, parental responsibility, perceived benefits, and perceived need instilled by the dentist.nnnCONCLUSIONSnFour global themes captured the motives of most parents seeking orthodontic treatment for their children. Understanding these global themes can help clinicians frame their treatment discussions with parents.

Retrospective investigation of the effects and efficiency of self-ligating and conventional brackets

INTRODUCTIONnThe purpose of this retrospective cohort study was to assess the effects and efficiency of self-ligating brackets compared with conventional brackets. A secondary purpose was to identify the pretreatment factors associated with the choice of self-ligating or conventional brackets.nnnMETHODSnThe subjects were treated by 2 private practitioners who used both self-ligating and conventional brackets in their practices. The self-ligating subjects were consecutively identified (treatment completed between January 2011 and April 2012), and then an age- and sex-matched control group was chosen from the same office. The outcome measures were changes in arch dimensions, changes in mandibular incisor inclinations, final peer assessment rating (PAR) scores, percentages of PAR reduction, overall treatment times, total number of visits, and number of emergency visits. All cast and cephalometric measurements were performed on digital records in a blinded manner. Two calibrated assessors measured the PAR scores.nnnRESULTSnThe final sample comprised 74 patients from clinician 1 and 34 patients from clinician 2. The practitioners had significant differences for several treatment parameters; therefore, the data from the 2 clinicians were analyzed separately. For clinician 1, no significant differences were observed between the self-ligating and conventional groups, other than increased arch length in the self-ligating group. The self-ligation patients treated by clinician 2 demonstrated significant increases in transverse dimensions, lower percentages of reduction in PAR scores, shorter treatment times, fewer visits, and more wire-sliding emergencies than the conventional bracket group.nnnCONCLUSIONSnAlthough some significant findings were observed, the small sample and the lack of consistent findings between the 2 clinicians made it difficult to draw strong conclusions.

Characteristics and fate of orthodontic articles submitted for publication: An exploratory study of the American Journal of Orthodontics and Dentofacial Orthopedics

INTRODUCTIONnIn this study, we aimed to give insight into the article review process by investigating the characteristics and the fate of manuscripts submitted to the American Journal of Orthodontics and Dentofacial Orthopedics (AJO-DO).nnnMETHODSnThe following information was obtained for original articles submitted to the AJO-DO inxa02008: (1) for rejected articles: the reasons for rejection and the journal of subsequent publication when applicable; (2) for accepted articles: the number of revisions and the time elapsed to publication; and (3) for all articles: study topic, study design, area of origin, and statistically significant findings. Findings were reported using descriptive statistics, the chi-square test for equality of proportions, and multiple regression where appropriate. Post-hoc pair-wise tests were checked against the Bonferroni correction to account for multiple testing.nnnRESULTSnOf the 440 original articles submitted to AJO-DO in 2008, 116 (26%) were accepted and published an average of 21xa0months (SD, 5xa0months) after acceptance. Rejected articles totaled 324 (74%), with 137 (42%) finding subsequent publication an average of 22xa0months (SD, 11xa0months) after rejection by the AJO-DO. The top 3 reasons for rejection by the AJO-DO were (1) poor study design (59% of rejected articles), (2) outdated or unoriginal topic (42%), and (3) inappropriate for the AJO-DOs audience (27%). Manuscripts rejected for poor study design had the least success for subsequent publication, whereas those rejected as inappropriate for the AJO-DO had the highest rate of publication elsewhere. Area of origin was significantly associated with acceptance by the AJO-DO, with articles from United States and Canada most likely to be accepted (Pxa0<xa00.01). Articles from countries with the lowest publication rate in the AJO-DO had the highest publication rate elsewhere. The presence of statistically significant findings was shown to be significantly associated with acceptance by the AJO-DO (Pxa0=xa00.013) but not with publication elsewhere (Pxa0=xa00.77).nnnCONCLUSIONSnRejection by the AJO-DO does not preclude publication elsewhere, although articles rejected for poor study design were least likely to be eventually published. Many publishable articles are rejected by the AJO-DO as inappropriate for its readership, and these were the most likely to find publication elsewhere. Articles with the highest chance of acceptance by the AJO-DO were those from the United States and Canada and those reporting statistically significant results.

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

In vitro adhesive bond strength studies mislead clinicians

1. Daratsianos N, Jäger A, Eliades T, Bourauel C. In vitro cyclic shear fatigue of the bracket-adhesive complex: A pilot study. J Orofac Orthop 2012;73:138-50. 2. Iliadi A, Baumgartner S, Athanasiou AE, Eliades T, Eliades G. Effect of intraoral aging on the setting status of resin composite and glass ionomer orthodontic adhesives. Am J Orthod Dentofacial Orthop 2014;145:425-33. 3. Eliades T, Brantley WA. The inappropriateness of conventional orthodontic bond strength assessment protocols. Eur J Orthod 2000;22:13-23. 4. Eliades T, Brantley WA. Orthodontic Applications of Biomaterials – A Clinical Guide. Abington, Cambridge: Published by Woodhead Publishing Series in Biomaterials, Elsevier Ltd.; Copyright @ 2017. For some time, the performance of bonded, fixed orthodontic appliances has been investigated using “in vitro,” “in vivo,” and “ex vivo” study designs. However, of these designs, only the results of “in vivo” clinical studies on humans can be directly extrapolated to everyday clinical orthodontic practice. Laboratory approaches most often arrive at clinically irrelevant conclusions due to many factors that cannot be simulated “in vitro,” including (a) the effect of bond fatigue due to load development during mastication,[1] (b) the aging of materials, particularly that of adhesives,[2] due to the temperature fluctuations, enzymatic degradation, salivary exposure, and pH changes, and (c) various methodological problems related to experimental procedures, ranging from selection and maintenance of teeth to load alignment during testing.[3] Despite certain limitations, “in vivo” studies of orthodontic bonding systems provide the best direct evidence on their clinical performance.