Trevor Hodge

A randomized clinical trial comparing the accuracy of direct versus indirect bracket placement

Objective To determine the accuracy of direct or indirect bracket placement. Design A prospective, randomized comparison of 2 different methods of bracket placement. Setting Queens Hospital, Burton upon Trent, UK between February and May 2001. Materials and method Twenty-six consecutive patients requiring upper and lower MBT™ pre-adjusted Edgewise appliances had their labial segments bonded directly or indirectly according to a split mouth system of allocation. Before and after bond-up all brackets were photographed and measured from tracings to determine positional differences from the ideal. Results Using ANOVA (General Linear Model), vertical errors were found to be greater than those in the horizontal plane, which in turn were greater than angular errors (p<0.05). Errors were greater in the maxillary arch than in the mandibular arch. There was no significant difference between the mean errors produced by the two methods of bracket placement. Conclusions Mean bracket placement errors were similar with both techniques.

Orthodontic treatment and cemento-osseous dysplasia: a case report

This report presents a case of florid cemento-osseous dysplasia (FCOD), affecting the mandibular teeth, in a 23-year-old Somalian female patient for whom orthodontic treatment was undertaken. The presenting features of the patient and the effect of orthodontic treatment on this case are discussed.

Choosing a pre-adjusted orthodontic appliance prescription for anterior teeth

A common orthodontic task is to correct anterior tooth position using brackets whose torque, tip and in-out are pre-adjusted. Bracket prescription greatly influences final aesthetics and function. Pre-adjusted orthodontic brackets have in-built prescriptions of torque, tip and in-out which are optimized for average cases. Refinement of tooth position can be achieved by archwire adjustment or archwire auxiliaries. Modifications to bracket position such as inversion can also help achieve individual tooth movements. Planning bracket position must be considered at the outset of treatment to achieve the maximum benefit. A number of clinical scenarios will be discussed including: a Class II division 1 malocclusion with lateral incisors palatally displaced, and another case with absent lateral incisors for space closure. Also, Class III malocclusions with consideration given to: canine angulation; a palatally displaced canine requiring labial movement; absent upper central incisors (space closure), and finally, a Class III case where incisor inclination requires consideration. By using a typodont to illustrate some of the points, this article aims to (1) show how three pre-adjusted orthodontic bracket systems (Andrews, Roth and MBT) vary significantly in their ability to influence tooth position and appearance; (2) inform clinicians how modified bracket position can influence tooth position.

The effect of using an audience response system on learning, motivation and information retention in the orthodontic teaching of undergraduate dental students: a cross-over trial

Objective New methods of teaching and learning are constantly being sought in the adult learning environment. Audience Response Systems (ARS) have been used in many different learning environments, especially in the field of medical education. The objective of this investigation was to ascertain the effect of ARS use in undergraduate teaching in a UK dental school. Design A cross-over clustered randomized educational trial. Setting Leeds Dental Institute. Participants Year 4 undergraduate dental students in orthodontics. Methods Students at Leeds Dental Institute were taught two different topics within the curriculum to test the use of ARS in a cross-over trial. A questionnaire was delivered to the test (ARS) and control (non-ARS) groups. Results The response rate to the questionnaires was 89·5% (test group) and 82·9% (control group). The ARS enabled students to perform better as shown by knowledge retention (P = 0·013). Students found the seminar more interesting (P = 0·013), easier to concentrate (P = 0·025) and easier to participate in (P = 0·020) when ARS was used. When ARS was used, students were more able to answer questions (P<0·0001), were more likely to prepare for the seminar (P<0·0001) and significantly preferred using ARS (P<0·0001). Conclusions ARS was found to significantly improve student concentration and participation in small group seminar teaching and significantly improved knowledge retention. ARS may be useful in facilitating orthodontic teaching in the future.

Orthodontic therapists--a challenge for the 21st century.

The introduction of orthodontic therapists in 2007 has led to significant changes to the delivery of orthodontic treatment in the UK. This article outlines the authors experience of training therapists on the Yorkshire Orthodontic Therapy Course and discusses challenges faced by this new way of providing orthodontics in the UK.

Clinical pearl In-treatment replacement of missing incisors

Four methods of in-treatment replacement of missing incisors are described.

American orthodontics Maurice Berman Prize 2005.

This paper describes the orthodontic treatment of two cases, which were awarded the 2005 Maurice Berman Prize.

Would the introduction of the Index of Orthognathic Functional Treatment Need (IOFTN) affect referrals and acceptance of people for orthognathic treatment

Introduction The Index of Orthognathic Functional Treatment Need (IOFTN) was developed to measure functional difficulties arising from malocclusions related to facial deformity. The IOFTN is not currently being used to determine suitability for orthognathic treatment, however, it is a useful aid for assessing and referring patients and takes into account functional and facial appearance. This paper aims to evaluate the potential impact of introduction of the IOFTN on the future provision of orthognathic services.Methods Two methods were used to consider the impact of the IOFTN on orthognathic provision. Firstly, a local retrospective audit was undertaken in Leeds Teaching Hospital NHS Trust involving thirty consecutively treated patients, for whom full records were retrieved. Data was collected using a standardised data caption form. Local standards were agreed concerning the need for treatment. Secondly, a systematic search of published studies was completed to assess evidence from across the UK.Results The audit standard, that is, 90% of patients treated with orthognathic surgery should be categorised as grade 4 (great need) or 5 (very great need) using the IOFTN, was fulfilled. The most common reason for seeking treatment related to dental and facial aesthetics and no patients were treated for speech or TMJ problems alone. The systematic review searches identified four suitable records for inclusion in the review, including two audits and two retrospective studies undertaken in secondary care settings across England and Scotland. These studies showed that at least 86% of all participants scored 4 or 5 using the IOFTN.Conclusions The findings from the audit and literature review indicate that referrals from general dentists and acceptance for orthognathic treatment in secondary care is unlikely to be significantly affected by introduction of the IOFTN. Referring dentists may find the IOFTN a useful prompt for determining whether people are suitable for orthognathic treatment.