Lorne D. Koroluk

External apical root resorption in Class II malocclusion: a retrospective review of 1- versus 2-phase treatment.

External apical root resorption (EARR) is an imperfectly understood problem of orthodontic treatment. The records of 138 children with Class II malocclusion (overjet > 7 mm) participating in a randomized clinical trial of early orthodontic treatment were reviewed. The patients were treated in either 1 phase with fixed appliances only (n = 49) or 2 phases with headgear (n = 49) or bionator (n = 40) followed by fixed appliances. The 3 groups were similar in age, sex, and malocclusion severity at enrollment. The records examined included anamnestic data, clinical examination records, panoramic radiographs before and after fixed appliance therapy, and posttreatment periapical radiographs. All radiographs were reviewed and scored independently by 2 examiners for maxillary incisor root development, morphology, and EARR. Of the 532 incisors scored, 11% of central and 14% of lateral incisors demonstrated moderate to severe (>2 mm) EARR. The proportion of incisors with moderate to severe EARR was slightly greater in the 1-phase treatment group. There was no difference in the incidence of EARR between teeth that had had trauma and those that had not, and there was only a slight increase in frequency of root resorption in teeth with unusual root morphology. Significant associations exist among EARR, the magnitude of overjet reduction, and the time spent wearing fixed appliances. However, not all incisors in a child respond in the same way, so other variables must play a role in determining the root response to orthodontic forces.

Relationship between body mass index percentile and skeletal maturation and dental development in orthodontic patients

INTRODUCTION The rate of obesity in children and adolescents is a current public health concern. The aim of this study was to investigate the relationship between body mass index (BMI) percentile and skeletal and dental maturity in adolescent orthodontic patients. METHODS Orthodontic patients between 8 and 17 years of age were assessed with a retrospective chart review. Skeletal maturation was assessed by using the cervical vertebral method, dental age with the Demirjian assessment method, and weight status with the BMI percentile. Linear regression and logistic regression models were used to assess the effect of the BMI percentile on dental age and cervical vertebral stage, respectively. RESULTS For this study, 540 subjects met the inclusion criteria; 27% of the boys and 32% of the girls were either overweight or obese. Cervical vertebral stage and dental age were more advanced in subjects with increased BMI percentiles. For dental age, the coefficient for the BMI percentile was 0.005 year per 1 unit of increase (P <0.001), and the odds ratio for the effect of the BMI percentile on the cervical vertebral method was 1.02 (P <0.001). CONCLUSIONS Orthodontists should consider weight status when evaluating growing children and adolescents because it can affect skeletal and dental development.

Effectiveness and efficiency of a CAD/CAM orthodontic bracket system

INTRODUCTION The first straight-wire appliance was introduced over 40 years ago to increase the consistency and efficiency of orthodontic treatment. More recently, computer-aided design and computer-aided manufacturing (CAD/CAM) technology has been used to create individualized orthodontic appliances. The purpose of this study was to investigate the clinical effectiveness and efficiency of CAD/CAM customized orthodontic appliances compared with direct and indirect bonded stock orthodontic brackets. METHODS This retrospective study included 3 treatment groups: group 1 patients were direct bonded with self-ligating appliances, group 2 patients were indirect bonded with self-ligating appliances, and group 3 patients were indirect bonded with CAD/CAM self-ligating appliances. Complete pretreatment and posttreatment records were obtained for all patients. The American Board of Orthodontics (ABO) Discrepancy Index was used to evaluate the pretreatment records, and the posttreatment outcomes were analyzed using the ABO Cast-Radiograph Evaluation. All data collection and analysis were completed by 1 evaluator. RESULTS There were no statistically significant differences in the ABO Discrepancy Index or the ABO Cast-Radiograph Evaluation among the groups. Treatment times for the 3 groups were significantly different; the CAD/CAM group was the shortest at 13.8 ± 3.4 months, compared with 21.9 ± 5.0 and 16.9 ± 4.1 months for the direct bonded and indirect bonded groups, respectively. The number of treatment appointments for the CAD/CAM group was significantly fewer than for the direct bonded group. CONCLUSIONS The CAD/CAM orthodontic bracket system evaluated in this study was as effective in treatment outcome measures as were standard brackets bonded both directly and indirectly. The CAD/CAM appliance was more efficient in regard to treatment duration, although the decrease in total archwire appointments was minimal. Further investigation is needed to better quantify the clinical benefits of CAD/CAM orthodontic appliances.

Characterizing the orthodontic patient's purchase decision: A novel approach using netnography

Introduction: A deeper and more thorough characterization of why patients do or do not seek orthodontic treatment is needed for effective shared decision making about receiving treatment. Previous orthodontic qualitative research has identified important dimensions that influence treatment decisions, but our understanding of patients’ decisions and how they interpret benefits and barriers of treatment are lacking. The objectives of this study were to expand our current list of decision‐making dimensions and to create a conceptual framework to describe the decision‐making process. Methods: Discussion boards, rich in orthodontic decision‐making data, were identified and analyzed with qualitative methods. An iterative process of data collection, dimension identification, and dimension refinement were performed to saturation. A conceptual framework was created to describe the decision‐making process. Results: Fifty‐four dimensions captured the ideas discussed in regard to a patients decision to receive orthodontic treatment. Ten domains were identified: function, esthetics, psychosocial benefits, diagnosis, finances, inconveniences, risks of treatment, individual aspects, societal attitudes, and child‐specific influences, each containing specific descriptive and conceptual dimensions. A persons desires, self‐perceptions, and viewpoints, the publics views on esthetics and orthodontics, and parenting philosophies impacted perceptions of benefits and barriers associated with orthodontic treatment. Conclusions: We identified an expanded list of dimensions, created a conceptual framework describing the orthodontic patients decision‐making process, and identified dimensions associated with yes and no decisions, giving doctors a better understanding of patient attitudes and expectations. HighlightsNetnography provides unobtrusive and rich data for qualitative analysis.New factors were identified to more thoroughly characterize patient decision making.A conceptual framework was created to describe the decision‐making process.Internal and societal influences impact perceptions of benefits and barriers.