- Journal Details
- First Published
- 01 May 1967
- Publication timeframe
- 1 time per year
- Open Access
Orthodontic patient co-operation: a review of the clinician’s role in predicting and improving patient compliance
Page range: 5 - 12
This systematic narrative review outlines factors associated with patient co-operation during orthodontic treatment. The co-operation of orthodontic patients, related to oral hygiene, appliance wear, diet and appointment attendance, can be highly influential on treatment outcome and the development of a number of potential adverse effects. While each patient is an individual with unique variations, patient age, gender, socio-economic status, parental relationships and psychological factors have been regarded as potential predictors of compliance. The assessment of potential patient co-operation can be difficult. A number of predictive methods have been attempted, including survey-based scales and subjective measurements, although, at present, clinicians lack a reliable quantitative tool for co-operation determination. Through communication, clinicians may alter patient co-operation. However, an individualised, patient-centred approach and the development of a relationship between the orthodontist and the patient remain essential.
- Open Access
Page range: 13 - 20
It is reported that in New Zealand financially disadvantaged adolescents are less likely to access orthodontic treatment than the more affluent in society.
The aim of the study was to investigate the attitudes of a group of New Zealand orthodontists towards the current fee-for-service model of treatment funding. A second aim was to explore orthodontists’ perceptions of how the affordability of orthodontic treatment affects low socio-economic families.
As part of the project, 11 volunteer orthodontists were interviewed. A subsequent content analysis of the collected data was performed.
Most participants reported that parents would feel inadequate if they were unable to secure orthodontic treatment for their child; however, some participants also indicated that it was common for parents to ‘go without’ to fund their child’s treatment. Most participants maintained that the government should only fund treatment for severely disabling malocclusions but not other treatments due to the limited health budget and orthodontic treatment being primarily considered for aesthetic reasons. Some participants reported that if the government funded orthodontic treatment, it would result in over subscription and compromised standards of care.
Despite some low socio-economic families being unable to access orthodontic treatment because of the expense, the current fee-for-service model may be the best method for delivering high standards of orthodontic care.
- Open Access
The resistance to axial dislodgement of nickel titanium compression arch wire hooks – an in vitro study
Page range: 21 - 26
To evaluate the level of force required to axially dislodge nickel titanium compression hooks (Trillium Compression HookTM, Hespeler Orthodontics) placed on orthodontic arch wires in vitro.
Nickel titanium compression hooks were placed on arch wires with a specially designed pair of pliers. The resistance to axial dislodgement was tested on a total of 260 hooks placed in a standardised way on round (0.016″, 0.018″, 0.020″), square (0.020 × 0.020″) and rectangular (0.016 × 0.022″, 0.019 × 0.025″, 0.021 × 0.025″) stainless steel (Rocky Mountain Orthodontics), nickel titanium, or β-titanium (Hespeler Orthodontics) arch wires. The forces required to displace the hooks were recorded using an Instron tensile testing machine. The data were compared with the results reported in similar studies on stainless steel crimpable arch wire hooks.
The forces required to dislodge the compression hooks varied between 45.0 N and 161.9 N. The hook’s resistance to dislodgement was found to be high in all tested hook/wire combinations. The lowest recorded average dislodging force was found in the 0.020″ nickel titanium group and the highest average force was in the 0.016 × 0.022″ β-titanium group.
The forces needed to dislodge the tested nickel titanium compression arch wire hooks exceed the force levels previously reported for stainless steel crimpable arch wire hooks.
- Open Access
Page range: 27 - 34
Numerous studies have indicated that a malocclusion possibly affects young people’s well-being and oral health-related quality of life (OHRQoL). Dento-facial aesthetics may influence how people are judged and may elicit social consequences such as bullying and negative comments. The present study aimed to explore the impact of a malocclusion on young New Zealanders who sought subsidised treatment from the Wish for a Smile (WFAS) organisation and to determine their motivation for seeking care.
A qualitative thematic analysis of 151 application letters to WFAS from young people (aged 11–18 years) and their caregivers was supplemented by telephone interviews of nine successful and nine unsuccessful applicants to explore their experiences through their own words.
In both the letters and the interviews, young people most commonly reported psychological impacts, followed by social and emotional effects associated with their malocclusion. Physical impacts were less commonly reported. In their application letters, caregivers, although at lower frequencies, reported that the young people experienced the same impacts. One caregiver referred to the young person’s malocclusion as a temporary disability.
For some young people, a malocclusion may lead to social consequences that are disabling. When considering funding options, it is important to note the individual experience and the impact that a malocclusion might have upon the young person’s well-being.
- Open Access
Page range: 35 - 45
Valid patient consent is a legal and ethical principle that is fundamental to healthcare provision. Oral health practitioners (OHPs) must understand the principles that need to be addressed to ensure that the consent given by a patient is valid. Failure to obtain consent may result in a negligence claim or a complaint of professional misconduct against the OHP. Orthodontic treatment is mostly elective but is not without risk to the patient. Obtaining and maintaining valid consent for orthodontic treatment presents additional challenges in comparison with other dental procedures as the treatment lasts over a longer time and is most commonly performed in adolescents. In addition, prospective patients need to be informed regarding ‘lifelong’ management in the retention phase to minimise the risk of relapse. The present paper outlines the principles of valid consent with particular regard to orthodontic treatment in the adolescent patient. OHPs must ensure that they are satisfied that the competent patient has the capacity to voluntarily consent. Clinicians must also recognise that valid consent is not a one-off ‘tick the box’ procedural exercise but an ongoing process of effective information sharing in light of changing laws and an ever-changing scientific evidence base within a patient-centred model of healthcare.
- Open Access
Page range: 46 - 52
To investigate the prevalence of cervical vertebral anomalies (CVA) in a group of patients presenting with cleft lip and palate (CLP) and to compare with a non-cleft population.
The sample comprised of 150 lateral cephalograms of non-syndromic patients with CLP and 150 non-cleft age-matched controls. The age range of both groups covered 6 to 20 years. An expert radiologist blinded to the cleft status evaluated the cephalograms for CVA and categorised them into normal, fusion, dehiscence and multiple cervical anomalies. The cleft group was subdivided according to the types of cleft (UCLP/ BCLP/ CPO) and gender (male/female). The CVA prevalence was compared between the cleft and non-cleft patients.
The prevalence of CVA was 37.7% and 20.7% in cleft and non-cleft patients, respectively. The difference was statistically significant with a
A high prevalence of CVA was observed in cleft patients compared with non-cleft subjects. The prevalence of CVA was similar between males and females. The practitioner should carefully evaluate the lateral cephalogram of CLP patients for CVA, which otherwise may remain undetected and lead to neurological symptoms later in life.
- Open Access
Galvanic coupling and mechanical properties of low Ni orthodontic brackets with representative types of orthodontic wires
Page range: 53 - 60
To characterise the mechanical properties and galvanic coupling of Ni-free orthodontic brackets with stainless steel (SS) and Nickel-Titanium (NiTi) orthodontic wires.
Three Ni-free bracket types (Topic [TOP], Equilibrium [EQU] and Orthos [ORT] made of Ni-free alloys), one conventional (Mini 2000 [MIN]) made of SS alloy and an SS and a NiTi wire were examined in the present study. All brackets and wires were embedded in epoxy resin and, after metallographic grinding and polishing, the Martens hardness (HM), the indentation modulus (EIT), and the elastic index (ηIT) were recorded, employing Instrumented Indentation Testing (IIT) by monitoring force over indentation depth curves during a loading-unloading cycle. The galvanic coupling of all bracket-wire combinations was tested in 0.1M NaCl-0.1M lactic acid and 0.3% (wt.) NaF solutions by noting the potential differences over 48 hours. The mechanical properties were statistically analysed by one-way ANOVA and Tukey multiple comparison tests at alpha = 0.05.
Significant differences were identified in the mechanical properties of the materials tested. The TOP (2372 ± 182 N/ mm2), ORT (wing) (2418 ± 164) and SS wire (2302 ± 85) showed significantly higher HM compared with all other materials tested. The MIN (base) (1115 ± 81) and ORT (base) (1237 ± 101) showed the lowest HM while MIN (wing) (1520 ± 138), EQU (1620 ± 139) and NiTi wire (1526 ± 42) demonstrated intermediate HM values. The ORT (wing) (101 ± 6 GPa) displayed the highest EIT while NiTi wire (24 ± 5) showed the lowest. The latter had the highest elastic index (59 ± 5%) with MIN (base)(15 ± 3) possessing the lowest. The potential difference for all bracket wire combinations was found below the threshold for the initiation of galvanic corrosion (200 mV) apart from MIN coupled with NiTi wire in the NaF solution.
The mechanical properties of Ni-free brackets are significantly different compared with the SS bracket assessed. Galvanic testing revealed that conventional and Ni-free brackets are compatible with both SS and NiTi wires in media containing chloride and fluoride ions.
- Open Access
Page range: 61 - 70
Adult patients presenting with skeletal discrepancies may refuse surgical intervention.
Thirty-two patients who declined orthognathic correction of their maxillo-mandibular dysplasia and who were without signs of temporomandibular dysfunction (TMD) were offered mandibular repositioning as a non-invasive alternative. Simulating a skeletal correction, it was explained that the approach was based on results described in case reports.
Before commencing treatment, initial records, lateral and frontal head films, study casts and photos were obtained (T0) and the mandible was repositioned to camouflage a retrognathic skeletal discrepancy or a mandibular transverse asymmetry by means of an occlusal build-up using Triad™ gel.
Three months later (T1), 23 patients had adapted to the new occlusion reflected by an absence of functional disturbance and without fracture of the composite occlusal build-up. Mandibular position in these patients was maintained by additional orthodontic treatment and an adjustment of the occlusion to the built-up postured position (T1). The skeletal changes occurring during repositioning were assessed on sagittal and frontal head films while intra-articular changes occurring during a two-year follow-up period (T2) were evaluated on images constructed from CBCT scans. No significant change, either in the direction of relapse or in the direction of further normalisation of condylar position, were observed during the two-year observation period.
Mandibular repositioning is a non-invasive intervention that may be considered a valid alternative to surgery in selected patients. Morphological variables from the radiographs taken at T0 and the results of the initial clinical evaluation of dysfunction yielded only vague and insignificant indicators regarding the predictability of the adaptation. A CBCT scan at T0 might have contributed to the identification of the patients who would likely accept the repositioning.
- Open Access
Page range: 71 - 74
Orthodontic miniscrews are used to obtain skeletal anchorage during orthodontic treatment and their application is growing due to the simple method of placement and removal, which invites improved patient compliance without significant impact on function and aesthetics. However, complications and risks are reported that underscore the need for a thorough preoperative assessment to enable accurate placement, especially in confined sites. A novel approach is presented which employs a custom-designed 3D-printed splint to facilitate a fully-guided placement of orthodontic miniscrews.
The presented splint was virtually planned using coDiagnostiX® software after matching the DICOM data and STL file, to enable fully-guided screw insertion. Insertion depth was defined by a sleeve tube height that provided a depth stop when contact was reached with the head of the hand piece. Additionally, to prevent movement of the insertion instrument, a custom metallic sleeve was designed and 3D-printed by a metallic printer.
Accurate placement was achieved and no complications were experienced during insertion and use.
The insertion approach provides more predictable results and enables accurate placement of orthodontic screws. The procedure avoids associated risks and complications primarily encountered in difficult cases.
- Open Access
Page range: 75 - 84
Patients in active treatment and transferred to another orthodontic clinic may present a difficult challenge for the receiving orthodontist. The purpose of this case report is to illustrate and discuss the orthodontic therapy of a 35-year-old male who had been prepared for orthognathic surgery, transferred to a different clinic and whose treatment was revised to involve orthodontic camouflage. A reflection of the difficulties in managing transferred patients is offered, and the consequences of changing the original treatment plan and handling the patient’s expectations are explained.
- Open Access
Page range: 85 - 93
According to the WHO, a paradental cyst is classified as an odontogenic inflammatory lesion, showing a relative frequency of 0.9–4.7% in the world population. There are no identifiable reports of orthodontic treatment of patients who also present with a paradental cyst. The presenting patient was a Japanese female, aged 16 years and 10 months. The chief complaint was crowding and protrusion of the incisors. The magnitude of the overjet was +4.0 mm, overbite was +3.8 mm, and the intermolar relationship was Angle Class I. Pretreatment computed tomography identified a radiolucency extending from the root furcation to the apex of the mandibular left first molar, which was diagnosed as a paradental cyst. Orthodontic treatment was performed using lingual multi-bracket appliances and miniscrews following the extraction of the affected mandibular first molar, mandibular right first premolar and both maxillary first premolars. The paradental cyst was enucleated, and occlusal cusp-fossa relationships were maintained with complete space closure. This case is the first report of orthodontic treatment in association with the management of a paradental cys.
- Open Access
Page range: 85 - 93
Micro-osteoperforation (MOP) is a newly developed technique reported to accelerate orthodontic tooth movement.
The following case report discusses a peripheral ossifying fibroma (POF), as a reactive gingival nodule that developed eight weeks after a patient underwent transmucosal MOP at multiple sites in the mandible during orthodontic treatment.
The MOP procedure is a relatively new approach applied to orthodontics that may induce gingival reactive nodules. Clinicians should be aware of this possible sequela and inform patients of the potential risk.