Nicola E Atack

Comparative assessment of alignment efficiency and space closure of active and passive self-ligating vs conventional appliances in adolescents: a single-center randomized controlled trial.

INTRODUCTION The aim of this study was to compare the time to initial alignment and extraction space closure using conventional brackets and active and passive self-ligating brackets. METHODS One hundred adolescent patients 11 to 18 years of age undergoing maxillary and mandibular fixed appliance therapy after the extraction of 4 premolars were randomized with stratification of 2 age ranges (11-14 and 15-18 years) and 3 maxillomandibular plane angles (high, medium, and low) with an allocation ratio of 1:2:2. Restrictions were applied using a block size of 10. Allocation was to 1 of 3 treatment groups: conventional brackets, active self-ligating, or passive self-ligating brackets. All subjects were treated with the same archwire sequence and space-closing mechanics in a district general hospital setting. The trial was a 3-arm parallel design. Labial-segment alignment and space closure were measured on study models taken every 12 weeks throughout treatment. All measurements were made by 1 operator who was blinded to bracket type. The patients and other operators were not blinded to bracket type during treatment. RESULTS Ninety-eight patients were followed to completion of treatment (conventional, n = 20; active self-ligating brackets, n = 37; passive self-ligating brackets, n = 41). The data were analyzed using linear mixed models and demonstrated a significant effect of bracket type on the time to initial alignment (P = 0.001), which was shorter with the conventional brackets than either of the self-ligating brackets. Sidaks adjustment showed no significant difference in effect size (the difference in average response in millimeters) between the active and passive self-ligating brackets (the results are presented as effect size, 95% confidence intervals, probabilities, and intraclass correlation coefficients) (-0.42 [-1.32, 0.48], 0.600, 0.15), but the conventional bracket was significantly different from both of these (-1.98 [-3.19, -0.76], 0.001, 0.15; and -1.56 [-2.79, -0.32], 0.001, 0.15). There was no statistically significant difference between any of the 3 bracket types with respect to space closure. Space-closure times were shorter in the mandible, except for the Damon 3MX bracket (Ormco, Orange, Calif), where active and total space-closure times were shorter in the maxilla. No adverse events were recorded in the trial. CONCLUSIONS Time to initial alignment was significantly shorter for the conventional bracket than for either the active or passive self-ligating brackets. There was no statistically significant difference in passive, active, or total space-closure times among the 3 brackets under investigation.

Centralization of services: standard setting and outcomes

Objective To test specific standards set in the newly established cleft lip and palate service in three regions of the U.K. The standards relate to record collection and outcomes. Design Retrospective analysis. Patients Records of 31 children, 5 years of age, who were born in 1997 with complete unilateral clefts of lip and palate and were treated by surgeons in three regions. Main outcome measures Record collection standards were measured by collecting dental study models. Outcomes were measured with the 5-Year-Old Index. Results Of the 31 subjects, 52% had excellent and good outcomes. The 31 cases represented 62% of the total records collected. Conclusions The three regions examined fell short of the standards set, but the outcomes were improved compared with previous national outcomes. The failings in record collection need to be rectified. This study provides baseline data for further development of cleft services within three regions.

Structural outcomes in the Cleft Care UK study. Part 2: dento-facial outcomes

Structured Abstract Objectives To compare facial appearance and dento-alveolar relationship outcomes from the CSAG (1998) and CCUK (2013) studies. Setting and sample population Five-year-olds born with non-syndromic unilateral cleft lip and palate. Those in the original CSAG were treated in a dispersed model of care with low-volume operators. Those in CCUK were treated in a more centralized, high-volume operator model. Materials and methods We compared facial appearance using frontal view photographs (252 CCUK, 239 CSAG) and dental relationships using study models (198 CCUK, 223 CSAG). Facial appearance was scored by a panel of six assessors using a standardized and validated outcome tool. Dento-alveolar relationships were scored by two assessors using the 5-Year-Olds’ Index. Ordinal regression was used to compare results between surveys. Results Excellent or good facial appearance was seen in 36.2% of CCUK compared with 31.9% in CSAG. In CCUK, 21.6% were rated as having poor or very poor facial appearance compared with 27.6% in CSAG. The percentage rated as having excellent or good dento-alveolar relationships was 53.0% in CCUK compared with 29.6% in CSAG. In CCUK, 19.2% were rated as having poor or very poor dento-alveolar relationships compared to 36.3% in CSAG. The odds ratios for improved outcome in CCUK compared to CSAG were 1.43 (95% CI 1.03, 1.97) for facial appearance and 2.29 (95% CI 1.47, 3.55) for dento-alveolar relationships. Conclusions Facial and dento-alveolar outcomes were better in CCUK children compared to those in CSAG.

Peri-operative second molar tube failure during orthognathic surgery: two case reports

With improvements in bonding techniques, bracket base design and bond strengths, molar tubes are becoming more popular in orthodontics.1,2 Molar tubes make an attractive alternative to conventional banding due to a reduction in clinical bonding time and ease of placement on partially erupted teeth. The use of molar tubes negates the need for orthodontic separation and subsequent cementation of bands, and offers improved periodontal health.3 Their use on terminal molars, however, should be limited to non-orthognathic cases. This paper presents two cases of peri-operative second molar tube failure during orthognathic surgery. They are presented in the hope that it will highlight the importance of banding the distal terminal molar in orthognathic cases to prevent loss of molar tubes and peri-operative contamination of the surgical wound site.

Three-Dimensional Digital Models for Rating Dental Arch Relationships in Unilateral Cleft Lip and Palate:

Objective To determine the reliability and reproducibility of using three-dimensional digital models as an alternative to plaster models for rating dental arch relationships in patients born with unilateral cleft lip and palate. Design Reliability and reproducibility study. Methods Study models of 45 patients born with unilateral cleft lip and palate were made available in plaster and three-dimensional digital models. Records were scored a week apart by three examiners using the 5-year-olds’ index reference models in the same two formats as the patient models. To assess reproducibility the study was repeated 4 weeks later under similar conditions to minimize the influence of memory bias on the results. The reliability of using the three-dimensional digital models was determined by comparing the scores for each examiner with the plaster model scores. Results Weighted kappa statistics indicated repeatability for the plaster models was very good (.83 to .87). For the three-dimensional digital models it was good to very good (.74 to .83). Overall, the use of the three-dimensional digital models showed good agreement with the plaster model scores on both occasions. Conclusion Three-dimensional digital models appear to be a good alternative to plaster models for assessing dental arch relationships using the 5-year-olds’ index.

Effect of gender and Frankfort mandibular plane angle on orthodontic space closure: a randomized controlled trial.

OBJECTIVES To determine the effect of gender and Frankfort mandibular plane angle (FMPA) on extraction space closure. SETTING AND SAMPLE POPULATION A single district general hospital. The sample population were 11- to 18-year-olds undergoing upper and lower fixed appliance therapy following the loss of a premolar in each quadrant. METHODS A total of 100 patients undergoing upper and lower fixed appliance therapy following the loss of four premolars were randomized with stratification on two age ranges (11-14 years and 15-18 years) and three FMPAs (high, medium and low). Allocation was to one of three treatment groups: conventional, active or passive self-ligating brackets, with an allocation ratio of 1:2:2. All subjects were treated using the same archwire sequence and space closing mechanics. Space closure was measured on models taken every 12 weeks throughout treatment. All measurements were taken by one operator, blinded to bracket type. RESULTS A total of 98 patients were followed to completion. Data were analysed using linear mixed models and demonstrated no statistically significant difference between bracket types with respect to space closure. Therefore, the data were pooled to determine the effect of gender and FMPA on space closure. At all stages of space closure, there was a significant effect of gender (results are presented as effect size, lower and upper 95% confidence intervals and probability), that is passive [1.064, 0.521, 1.607, 0.001], active [0.825, 0.312, 1.339, 0.002] and total space closure [1.029, 0.527, 1.531, 0.001]. There was no statistically significant effect of FMPA on space closure. CONCLUSIONS Space closure during fixed appliance therapy is affected by gender but is unaffected by FMPA.

Experiences of Wiki topic teaching in postgraduate orthodontics: what do the learners think?

INTRODUCTION Traditionally, the academic content of many 3-year full-time postgraduate courses in orthodontics in the UK has been delivered using tutorial and lecture-based teaching. This is often teacher lead rather than learner centred. Even with the advent of teaching modules on the national virtual learning environment, although well liked by students, is still often teacher lead. An alternative on-line approach to learner-centred teaching is to use Wikis. MATERIALS AND METHODS Nine postgraduate students in the first term of their full-time 3-year specialist training programme at Bristol Dental School were divided into three groups and wrote a Wiki on three interrelated topics. This process was repeated in the second term using three different, but still interrelated topics. Following each, they were asked to give detailed feedback on their Wiki topic teaching. RESULTS AND DISCUSSION The results showed that students felt writing the Wikis was useful for team work, provided a more learner-centred approach, created a body of work in a live format that would be useful for revision and was a welcome variation on traditional teaching methods. The biggest problem encountered was the IT platform used to create the Wikis. The students also felt the Wikis should be assessed as a piece of group work rather than as separate individuals. CONCLUSIONS Wiki topic teaching is a useful tool in the teaching of postgraduate orthodontics providing variation and a more learner-centred approach. Further exploration of the available IT platforms is required.

Do I have enough time? The impact of recruiting patients to a randomised controlled trial at recruiting centres

Introduction This paper explores the impact of recruiting patients to a randomised controlled trial (RCT) at recruiting centres. This large multicentre RCT examining the efficacy of chewing gum compared to ibuprofen in the relief of orthodontic pain was carried out across nine recruiting centres.Method The work diaries of clinicians and supporting staff at recruiting centres were analysed over a four-month period from September to December 2011. This quantified the amount of clinical and non-clinical time spent on research duties.Results Over this time period 98 patients were recruited across seven trial sites. On average, patient recruitment had a direct clinical impact of 19 minutes per patient recruited. The time commitment on trial administration outside the clinical sessions was much higher, averaging at 110 minutes per patient recruited, giving the overall time spent on the trial 129 minutes per patient.Conclusions This information will be valuable to lead researchers when calculating the full economic cost of a proposed clinical trial and therefore when applying for grant funding. It may also be valuable to clinicians and their managers when considering becoming a principle investigator (PI) in a RCT. Although the impact on clinical time was 19 minutes per patient recruited, there is a considerably higher (almost six times greater) time commitment in administration around the recruitment of patients.

Who wears the braces? A practical application of adolescent consent.

The presentation of alternative treatment plans and the discussion of these options with the adolescent patient is a routine part of both general dental and specialist orthodontic practice. This article will cover the issues involved in obtaining consent for treatment from the adolescent patient and suggests a practical means, if appropriate, to ensure that these patients can give and withdraw consent for their own treatment.