N. A. Mandall

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.

Hawley retainers full- or part-time? A randomized clinical trial.

The aim of this trial was to compare two different orthodontic retention regimens: is night-only wear of upper and lower Hawley retainers for 1 year as effective as 6 months full-time followed by 6 months night-only wear? Sixty-seven consecutive patients attending for orthodontic debond were randomly allocated to wear upper and lower Hawley retainers either for 1 year night-only (group 1) or for 6 months full-time followed by 6 months night-only (group 2). In group 1, 41.2 per cent were males and 58.8 per cent were females and their mean age was 15.6 years [standard deviation (SD) 1.6 years]. In group 2, 24.2 per cent were males and 75.8 per cent were females and their mean age was 15.8 years (SD 1.2 years). Study models were taken at the start (T0) and end (T1) of treatment and 1 year post-debond (T2). Digital callipers were used to measure upper and lower labial segment irregularity using Littles index and upper and lower labial segment crowding. To evaluate differences between groups 1 and 2 t-tests were used. There were no statistically significant differences between the two retention regimens at T2 for labial segment irregularity or crowding (P > 0.05). Since both retention regimens were equally effective during the 1 year retention period, it would seem clinically acceptable to ask patients to wear their retainers at night only.

A randomized clinical trial to compare the Goshgarian and Nance palatal arch

The aim of this trial was to evaluate whether a Nance or Goshgarian palatal arch was most effective for prevention of mesial drift, distal tipping, prevention of mesio-palatal rotation of the upper first permanent molars, and patient comfort and ease of removal. Patients were recruited from a district general hospital and a specialist orthodontic practice and randomly allocated to a Goshgarian (n = 29) or a Nance (n = 28) group. Pre-treatment study models (T1) were taken followed by the placement of the palatal arch, premolar extractions, and upper and lower fixed appliances. The clinical end point was 6 months (T2), at which time, an impression for an upper study model was taken. The amount of upper first permanent molar mesial movement, distal tipping, and mesio-palatal rotation was measured by scanning T1 and T2 study models and then using a software program to calculate molar changes. In addition, the patients recorded their discomfort scores using a seven-point Likert scale at each recall visit. Forty-nine patients (86 per cent) completed the trial. t-tests were used to compare molar movements between the Goshgarian and Nance palatal arch groups. There were no statistically significant differences between the palatal arches in terms of prevention of mesial drift or distal tipping (P > 0.05). There was a statistically significant difference in the amount of molar rotation between the arch types, with both exhibiting some disto-palatal rotation even though they were not activated for this movement. The Goshgarian palatal arch produced marginally more disto-palatal rotation than the Nance arch (P = 0.02), although this may not be considered clinically significant. A Mann-Whitney test revealed that there was also a statistically significant difference in pain scores between the Goshgarian and the Nance arch, with the latter being associated with more discomfort (P = 0.001). This trial did not support any preference in the use of the Goshgarian or Nance palatal arch, unless the slightly reduced patient discomfort with the Goshgarian arch is considered significant.

Are specialist outreach clinics for orthodontic consultation effective? A randomised controlled trial.

OBJECTIVE To develop outreach clinics for orthodontic consultation and evaluate their costs and effectiveness. DESIGN Single centre randomised controlled trial with random allocation of referred patients to outreach or main base consultation appointments. SETTING One hospital orthodontic department and three community health centre clinics in Greater Manchester. Subjects 324 patients who were referred for orthodontic treatment. MAIN OUTCOME MEASURES The outcome of consultation, the cost and duration of the visit and the consumers perceptions of the visit. RESULTS There were no differences in outcome of the consultation. While consumer travel costs and the duration of appointments were significantly higher for the main base clinics, these differences were not great. However, consumers preferred to attend an appointment in an outreach clinic. CONCLUSIONS There do not appear to be marked advantages or disadvantages in providing consultation appointments for orthodontics in outreach clinics

The role of removable appliances in contemporary orthodontics.

Removable appliances are capable of simple tipping movements and allow differential eruption of teeth using biteplanes The use of removable appliances are considerably more limited than in the past This paper explains the indications for use of removable appliances in contemporary orthodontics Removable appliances are capable of simple tipping movements and allow differential eruption of teeth using biteplanes The use of removable appliances are considerably more limited than in the past This paper explains the indications for use of removable appliances in contemporary orthodontics

Does the ethnicity of teenage children influence oral self perception and prevalence of dental disease

Aim: The primary aim was to evaluate the effect of ethnicity, social deprivation and oral health on oral self perceptions of 14-15-year-old Asians and Whites. A secondary aim was to assess the influence of ethnicity and social deprivation on oral treatment need in the same sample.Design: A cross-sectional epidemiological study.Data source: A stratified, random sample of 408 14-15-year-old Asian and White children from schools in Manchester.Method: Information was collected on oral self perceptions using a questionnaire and on oral treatment need with a clinical examination.Results: Multivariate data analysis revealed that oral treatment need, but not ethnicity or social deprivation, was an important predictive variable with respect to oral self perceptions. Ethnicity was the only variable to influence periodontal treatment need. Social deprivation influenced the level of untreated caries.Conclusions: 1. Socially deprived children have higher caries levels than their more affluent counterparts and this is evident regardless of ethnic background. 2. Although Asian 14-15-year-old children have a higher periodontal treatment need than Whites, there was no ethnic influence on how they perceive their oral health. 3. Oral treatment need is an important factor with respect to oral self perceptions

An alternative to study model storage

The aim of this investigation was to evaluate whether the same orthodontic information can be obtained from study models and photographs of study models for the purposes of medico-legal reporting. Thirty sets of study models were obtained from orthodontic patients treated at the University of Manchester, UK. A mix of start and finish study models were chosen, with the start study models showing a range of malocclusions. Photographs of the study models were taken: anterior and right and left buccal views in occlusion and upper and lower occlusal views. Three examiners assessed the study models and photographs of the models in a random order. They recorded diagnostic information that would be useful for medico-legal reporting. This information was then compared for study models versus photographs of study models using intraclass correlation coefficients (ICCs) for interval data [overjet (mm), midline discrepancy (mm), and number of missing teeth] and kappa (kappa) and percentage agreement for the remaining variables. Generally, agreement between the information obtained from study models versus photographs of study models was high with kappa values being above 0.70 for most variables. The exception to this was overbite with kappa values ranging from 0.66 to 0.74. When ICCs were considered, again the two methods compared very favourably.