Jean Wright

Effectiveness of early orthodontic treatment with the Twin-block appliance: a multicenter, randomized, controlled trial. Part 1: Dental and skeletal effects.

This study evaluated the effectiveness of early orthodontic treatment with the Twin-block appliance for the developing Class II Division 1 malocclusion. This multicenter trial was carried out in the United Kingdom. A total of 174 children, aged 8 to 10 years old, with Class II Division 1 malocclusion were randomly allocated to receive treatment with a Twin-block appliance or to an untreated, control group. Data were collected at the start of the study and 15 months later. Results showed that early treatment with Twin-block appliances resulted in reduction of overjet, correction of molar relationships, and reduction in severity of malocclusion. Most of this correction was due to dentoalveolar change, but some was due to favorable skeletal change. Early treatment with the Twin-block appliance is effective in reducing overjet and severity of malocclusion. The small change in the skeletal relationship might not be considered clinically significant.

Effectiveness of treatment for Class II malocclusion with the Herbst or twin-block appliances: a randomized, controlled trial.

The aim of this study was to evaluate the effectiveness of Herbst and Twin-block appliances for established Class II Division I malocclusion. The study was a multicenter, randomized clinical trial carried out in orthodontic departments in the United Kingdom. A total of 215 patients (aged 11-14 years) were randomized to receive treatment with either the Herbst or the Twin-block appliance. Treatment with the Herbst appliance resulted in a lower failure-to-complete rate for the functional appliance phase of treatment (12.9%) than did treatment with Twin-block (33.6%). There were no differences in treatment time between appliances, but significantly more appointments (3) were needed for repair of the Herbst appliance than for the Twin-block. There were no differences in skeletal and dental changes between the appliances; however, the final occlusal result and skeletal discrepancy were better for girls than for boys. Because of the high cooperation rates of patients using it, the Herbst appliance could be the appliance of choice for treating adolescents with Class II Division 1 malocclusion. The trade-off for use of the Herbst is more appointments for appliance repair.

Early treatment for Class II Division 1 malocclusion with the Twin-block appliance: a multi-center, randomized, controlled trial.

INTRODUCTION The aim of this study was to evaluate the effectiveness of early orthodontic treatment with the Twin-block appliance for the treatment of Class II Division 1 malocclusion. This was a multi-center, randomized, controlled trial with subjects from 14 orthodontic clinics in the United Kingdom. METHODS The study included 174 children aged 8 to 10 years with Class II Division 1 malocclusion; they were randomly allocated to receive treatment with a Twin-block appliance or to an initially untreated control group. The subjects were then followed until all orthodontic treatment was completed. Final skeletal pattern, number of attendances, duration of orthodontic treatment, extraction rate, cost of treatment, and the childs self-concept were considered. RESULTS At the end of the 10-year study, 141 patients either completed treatment or accepted their occlusion. Data analysis showed that there was no differences between those who received early Twin-block treatment and those who had 1 course of treatment in adolescence with respect to skeletal pattern, extraction rate, and self-esteem. Those who had early treatment had more attendances, received treatment for longer times, and incurred more costs than the adolescent treatment group. They also had significantly poorer final dental occlusion. CONCLUSIONS Twin-block treatment when a child is 8 to 9 years old has no advantages over treatment started at an average age of 12.4 years. However, the cost of early treatment to the patient in terms of attendances and length of appliance wear is increased.

Prospective, multi-center study of the effectiveness of orthodontic/orthognathic surgery care in the United Kingdom

INTRODUCTION The aim of this study was to evaluate the effectiveness of orthodontic/orthognathic surgical care provided in the North West region of England. It was an observational, prospective cohort study at 13 maxillofacial clinics in the United Kingdom. METHODS The 131 patients comprised 47 males (35.9%) and 84 females (64.1%), with an average age of 22.6 years. They received orthodontic/orthognathic treatment according to the normal protocols of the operators. They were then followed until all orthodontic treatment was completed. Final skeletal pattern, final peer assessment rating score, number of attendances, and duration of treatment were recorded. RESULTS At the end of the 5-year study, 94 patients had completed treatment, and 71 had complete data. Data analysis showed that, overall, the treatments provided were effective in terms of skeletal and dental occlusal outcomes; the final mean peer assessment rating score was 10.58. However, treatment duration was longer than commonly expected, with a mean length of 32.8 months (SD,11.3). The outcome of treatment was influenced by only pretreatment skeletal discrepancy. CONCLUSIONS This prospective investigation showed that orthodontic/orthognathic surgical care was effective. The outcome of treatment was influenced only by the severity of the pretreatment skeletal discrepancy.

Factors influencing the uptake of orthodontic treatment.

The aim of this investigation was to evaluate the factors that influenced the uptake of orthodontic treatment for patients who were referred for orthodontic treatment to two types of orthodontic treatment provider; a fee per item and hospital service. The following data were collected: (i) basic demographic data; (ii) the need for orthodontic treatment as measured by IOTN; and (iii) the outcome of the consultation. The data analysis with logistic regression revealed that the following variables had a predictive effect on the uptake of treatment: (i) the need for orthodontic treatment; and (ii) the patients gender. Most of the patients that were referred and accepted for treatment had a definite need for orthodontic treatment.

Early treatment for Class II malocclusion and perceived improvements in facial profile

INTRODUCTION The aims of this study were to assess whether early Twin-block appliance treatment improves the attractiveness of Class II profiles and to determine the orofacial features of a profile that most influence the perception of attractiveness. METHODS Silhouetted profiles of 20 treated patients and 20 untreated controls randomly selected from 174 subjects (ages, 8-10 years) of a randomized, controlled trial into the effectiveness of early Class II treatment were assessed by 30 children (ages, 10-11 years) and 24 teaching staff using a 5-point Likert scale. Independent samples t tests were used to compare attractiveness ratings between the treated and untreated groups. Linear regression was used to determine the features defining attractiveness. RESULTS Early orthodontic treatment resulted in improved perceptions of facial profile attractiveness. Profiles were likely to be rated as attractive if the overjet was smaller (P = 0.001) and no teeth showed (P <0.05). CONCLUSIONS Profile silhouettes of children who had received early orthodontic treatment for Class II malocclusion were perceived to be more attractive by peers than those of children who did not receive treatment.

The effect of orthodontic referral guidelines: a randomised controlled trial.

OBJECTIVE To develop and evaluate the effectiveness of referral guidelines for the referral of orthodontic patients to consultant and specialist practitioner orthodontists. DESIGN Single centre randomised controlled trial with random allocation of referral guidelines for orthodontic treatment to general dental practitioners. SETTING Hospital orthodontic departments and specialist orthodontic practices in Manchester and Stockport. SUBJECTS General dental practitioners and the patients they referred for orthodontic treatment. MAIN OUTCOME MEASURE Appropriateness of referral, defined as whether the patient was accepted for orthodontic treatment. RESULTS The referral guidelines did not reduce the number of inappropriate referrals. CONCLUSIONS Referral guidelines for orthodontic referrals did not influence the behaviour of the general dental practitioners. More research into the optimum methods of dissemination and implementation of referral guidelines for use in the general dental service is needed.

orthodontics: The effect of orthodontic referral guidelines: a randomised controlled trial

Objective To develop and evaluate the effectiveness of referral guidelines for the referral of orthodontic patients to consultant and specialist practitioner orthodontists.Design Single centre randomised controlled trial with random allocation of referral guidelines for orthodontic treatment to general dental practitioners.Setting Hospital orthodontic departments and specialist orthodontic practices in Manchester and Stockport.Subjects General dental practitioners and the patients they referred for orthodontic treatment.Main outcome measure Appropriateness of referral, defined as whether the patient was accepted for orthodontic treatment.Results The referral guidelines did not reduce the number of inappropriate referrals.Conclusions Referral guidelines for orthodontic referrals did not influence the behaviour of the general dental practitioners. More research into the optimum methods of dissemination and implementation of referral guidelines for use in the general dental service is needed.

A critical assessment of orthodontic standards in England and Wales (1990-1991) in relation to changes in prior approval.

Targeting, use of appliances, and standards of outcome for General Dental Service orthodontic cases collected between 1990 and 1991 were compared with a sample of cases from an earlier study, collected between 1987 and 1988, using the PAR index and IQTN. Comparisons are made generally and in relation to the changes in prior approval regulations for cases started since October 1987. More tower-need cases were treated, but there were no more ‘unnecessary’ treatments and there has been a limited improvement in outcomes, as assessed by the indices, associated with increased use of fixed appliances since 1987. Prior approval appeared to give no tangible benefits in terms of levels of unnecessary treatment or quality of outcome.

CLINICAL GUIDELINES FOR DENTISTRY : WILL THEY BE USEFUL?

Objective: To review the literature on the development and effectiveness of clinical guidelines.Design: Literature review of relevant publications following a Medline search. Publications that reported studies investigating effectiveness of guidelines were confined to randomised controlled trials.Conclusions: If guidelines are to be effective they should be (i) based on high levels of scientific evidence, (ii) developed with input from the dentists who will be using them and (iii) presented in a satisfactory manner. Importantly, the effectiveness of the guidelines should be rigorously evaluated