Journal & Issues

Volume 39 (2023): Issue 1 (January 2023)

Volume 38 (2022): Issue 2 (January 2022)

Volume 38 (2022): Issue 1 (January 2022)

Volume 37 (2021): Issue 2 (January 2021)

Volume 37 (2021): Issue 1 (January 2021)

Volume 36 (2020): Issue 2 (January 2020)

Volume 36 (2020): Issue 1 (January 2020)

Volume 35 (2019): Issue 2 (January 2019)

Volume 35 (2019): Issue 1 (January 2019)

Volume 34 (2018): Issue 2 (January 2018)

Volume 34 (2018): Issue 1 (January 2018)

Volume 33 (2017): Issue 2 (January 2017)

Volume 33 (2017): Issue 1 (January 2017)

Volume 32 (2016): Issue 2 (January 2016)

Volume 32 (2016): Issue 1 (January 2016)

Volume 31 (2015): Issue 2 (January 2015)

Volume 31 (2015): Issue 1 (January 2015)

Journal Details
Format
Journal
eISSN
2207-7480
First Published
01 May 1967
Publication timeframe
1 time per year
Languages
English

Search

Volume 35 (2019): Issue 2 (January 2019)

Journal Details
Format
Journal
eISSN
2207-7480
First Published
01 May 1967
Publication timeframe
1 time per year
Languages
English

Search

14 Articles
Open Access

Reducing iatrogenic complications in the treatment of cleft lip and palate

Published Online: 20 Jul 2021
Page range: 110 - 118

Abstract

Abstract

All patients receiving orthodontic treatment with fixed appliances have a significantly higher risk of developing white spot lesions (WSLs), which are considered the most common iatrogenic complication of treatment.

Cleft lip and/or palate (CLP) is a common craniofacial anomaly occurring in approximately one in 800 births. Patients affected by cleft lip and/or palate tend to have poorer oral hygiene and a greater risk of WSLs and caries than non-cleft sibling controls. Patients presenting with a cleft lip and/or palate also have a higher prevalence of molar-incisor hypomineralisation (MIH), which suggests that clinicians involved in the oral health management of cleft patients need to consider all available caries prevention protocols.

Cases presenting with hypomineralised teeth create more difficulty in bonding attachments to affected enamel using an acid etch technique and a composite resin material due to the abnormal prism structure. The bond strength to hypomineralised enamel can be as low as two-thirds that of the bond strength to unaffected enamel, which may not be adequate for routine fixed appliance treatment. Furthermore, the removal of orthodontic brackets from hypomineralised enamel may lead to more severe damage to the affected teeth.

Resin modified glass-ionomer cement (RMGIC), bonded after conditioning the enamel with polyacrylic acid, creates no resin tags as a result of a chemical rather than a mechanical bond. Therefore, there is less enamel loss during bracket debonding when compared with acid-etch preparation and composite resin bonding.

Furthermore, in cases in which the quality of the enamel is deficient causing limits to the shear bond strength of the acid-etched composite resin, the chemical bonding action of RMGIC overcomes the lack of adherence and protects the enamel.

RMGIC has cariostatic properties and clinical evidence supports the routine use of these adhesives for bonding in all fixed appliance cases as a strategy for reducing the incidence of white spot lesions and damage to the enamel during bracket debonding.

Open Access

The impact of orthodontic treatment on the dental occlusion and oral health-related quality of life of individuals with cleft lip and/or palate

Published Online: 20 Jul 2021
Page range: 119 - 126

Abstract

AbstractBackground

Children with cleft lip and/or palate (CL/P) are a special group of orthodontic patients. Oral health-related quality of life (OHRQoL) is an important aspect of treatment outcome that is becoming popular in its application in orthodontics, but its relationship with clinical treatment outcomes remains unclear.

Objectives

To compare OHRQoL and clinical treatment outcomes of a sample of children with cleft lip and/or palate and non-cleft children before and after orthodontic treatment in order to determine whether there is an association between the two outcome measures.

Methods

A prospective observational longitudinal study was conducted of 60 consecutive adolescent patients (33 CL/P and 27 non-cleft) who received orthodontic treatment at Christchurch Hospital, New Zealand. The two outcome measures were a self-reported OHRQoL outcome assessed by the short form 8 item Child Perception Questionnaire (CPQ-ISF 8) and an orthodontic treatment outcome assessed by the Peer Assessment Rating (PAR) index.

Results

Both CL/P and non-cleft groups had comparable pretreatment malocclusion severity with similar baseline and end of treatment OHRQoL. Although both groups showed similar improvements in OHRQoL following orthodontic treatment, the non-cleft group had significantly greater improvement in their PAR outcome. There was no association detected between OHRQoL and the PAR improvement.

Conclusion

Both study groups had similar OHRQoL changes following orthodontic treatment despite the non-cleft group having better orthodontic treatment outcomes. There is a lack of correlation between the patient’s self-assessment OHRQoL and clinically based orthodontic treatment outcomes.

Open Access

Effect of combined oral contraceptives on orthodontic tooth movement in a female rat model

Published Online: 20 Jul 2021
Page range: 127 - 133

Abstract

AbstractBackground

To investigate the effect of combined oral contraceptives (COC) on orthodontic tooth movement (OTM) and periodontal remodelling in a female rat model.

Methods

A total of 80 three-month-old female, Sprague-Dawley rats were randomly divided into experimental and control groups. The maxillary first molars were moved mesially using nickel-titanium coil springs (50 g force). The experimental group (N = 40) ingested 1.5 ml COC (Marvelon, 0.12 mg/d, N.V. Organon, Oss, The Netherlands) daily. The control group (N = 40) ingested 1.5 ml saline (0.9% sodium chloride) daily. After 7, 14, 21 and 28 days of force application, 10 rats in each group were euthanased and a vernier calliper was used to measure the orthodontic movement of the first molar. Root resorption at pressure areas was assessed by H and E staining. Micro-CT was used to detect alveolar bone mineral density.

Results and conclusion

The amount of OTM in the experimental group (0.46 ± 0.16 mm) was significantly less than in the control group (0.85 ± 0.25 mm; p = 0.003) during the 28 days of observation. There were significantly smaller (p = 0.002) root resorption lacunae in the experimental group (111710 ± 4037 pixels) compared with the control group (204962 ± 21318 pixels) after 28 days. There was no statistically significant difference in the bone mineral density between the experimental and control groups throughout the study period (p > 0.05 at each time point). The short-term administration of COC may retard tooth movement and reduce the level of root resorption during OTM in female rats.

Open Access

The effect of head posture on facial soft tissue changes captured by white-light facial scanning

Published Online: 20 Jul 2021
Page range: 134 - 142

Abstract

AbstractObjective

To investigate whether changes in head posture have significant effects on facial soft tissues during white-light scanning.

Materials and methods

Thirty-four adult patients participated in the study in which 22 soft tissue landmarks were marked on the face of each subject using an oil-based pen. The subjects wore digital inclinometers on top of their heads, and sat relaxed with their heads orientated in natural head position (NHP), while a facial scan was captured. The subjects underwent a second facial scan in an upward 5°(U5), upward 10°(U10), downward 5°(D5), or a downward 10°(D10) direction with respect to the NHP. The NHP image was superimposed on the images taken at the different head postures and a single co-ordinate system was obtained. The axial reference plane (x-axis), the sagittal reference plane (y-axis) and the coronal plane (z-axis) were set with N’ as the zero point (0, 0, 0). The changes in position of each landmark caused by the change of head posture were measured.

Results

When the subject’s head was in the U5 and D5 posture, changes in landmark identification were not statistically significantly different. When the subject’s head was in the U10 posture, soft tissue Stmi and Li moved downward significantly. Soft tissue pogonion moved forward significantly in the D10 posture.

Conclusions

Soft tissue changes within 5° of the natural head posture were clinically negligible. If efforts to reproduce natural head position are carried out, reliable facial scanning images can be obtained without the support of any special head positioning tools.

Open Access

Evaluation of treatment risks and the quality of information contained within the websites of specialist orthodontists

Published Online: 20 Jul 2021
Page range: 143 - 151

Abstract

AbstractObjective

To evaluate the treatment risks and the quality of information contained within the websites of specialist orthodontists in Australia.

Methods

The term ‘specialist orthodontic practice’ was entered into three internet search engines. Websites satisfying inclusion and exclusion criteria were evaluated for orthodontic treatment risk information against nine common treatment risks. For website reliability and quality, the DISCERN instrument was used along with the HON (health on the net) seal certification; and for readability, the Flesch Reading Ease (FRE) Test was applied.

Results

Of the 105 websites that met the inclusion and exclusion criteria, 4.8% reported all nine risks. No risks were reported by 17.1%. Relapse (64.8%) was the most common risk recorded on websites, followed by ‘pain/discomfort’ (63.8%). Root resorption was reported by 5.7%. The requirement for life-long retention was indicated by 22.9% of the websites and 57.1% gave advice on sports mouthguard wear. The proposed benefits of orthodontic treatment were outlined by 85.7%. The mean (standard deviation [SD]) overall DISCERN score was 43.78 (SD 6.49; range 17–59). No website displayed the HON Seal certification. The mean FRE Score was 51.71 (SD 10.19; range 30.1–74.7).

Conclusions

Information regarding orthodontic treatment risks contained within specialist orthodontic practice websites appears deficient. Websites were of variable reliability, quality and readability. Further development of specialist orthodontists’ websites is required to ensure the delivery of accessible, reliable and understandable evidence-based information to patients.

Open Access

Interceptive orthodontic practices in general dentistry: a cross-sectional study

Published Online: 20 Jul 2021
Page range: 152 - 157

Abstract

AbstractObjectives

To evaluate the current practice of interceptive orthodontics undertaken by general dental practitioners and identify influencing factors.

Materials and methods

Printed questionnaires were provided to 200 registered Australian general dental practitioners. Participants were questioned about their current confidence, attitudes, and practice, related to interceptive orthodontics in general dentistry.

Results

The decision to practise interceptive orthodontics (17.4% of respondents) was strongly dependent on the confidence of the dentist (x2 = 48.693; df = 4; p < 0.001). It was also found that the provision of interceptive orthodontics was prevented by its perceived importance (x2 = 23.559; df = 5; p < 0.001) and benefit in a general dental setting (x2 = 9.411; df = 4; p = 0.035). The provision of more education was not shown to likely increase the number of dentists performing interceptive orthodontics. Low clinician confidence in the provision of interceptive orthodontics was also shown to result in orthodontic consultation prior to performing treatment (x2 = 31.782; df = 16; p = 0.004) or referral to an orthodontist (x2 = 42.465; df = 12; p < 0.001).

Conclusions

Interceptive orthodontics was not practised by most dentists. This decision was shown to be influenced by the clinicians’ confidence, further education or training, perceived importance of interceptive orthodontics and the impact that early intervention might have on future orthodontic treatment. Consideration should also be given to clarifying the orthodontic scope of practice for general dentists, in order to reduce the confusion influencing the provision of orthodontic care.

Open Access

Evaluation of skeletally anchored therapy using miniplates and micro-implants in skeletal Class III treatment

Published Online: 20 Jul 2021
Page range: 158 - 166

Abstract

AbstractBackground/aim

To compare the outcomes of skeletally-anchored (SA) or face mask (FM) therapy in the management of patients presenting with maxillary retrognathia.

Methods

Forty-four consecutively treated maxillary retrognathic patients who underwent SA or FM therapies followed by fixed orthodontics were evaluated. Two micro-implants between the maxillary first molar and the second premolar and two mandibular miniplates were inserted to facilitate the use of Class III elastics in the SA group (23 patients). Facemasks with full occlusal-coverage acrylic appliances were applied in the FM group (21 patients). Lateral cephalometric radiographs obtained before treatment (T0), after orthopaedic treatment (T1), and after fixed orthodontic treatment (T2) were traced and 31 measurements compared.

Results

No statistically significant differences were found between the groups related to treatment duration and gender distribution. The mean age was significantly higher in the SA group (11.70±0.25 years) compared with the FM group (10.57±0.35 years) at T0. The mean ANB angle increased by 3.34° and 3.15° and the mean Wits value reduced by 6.16 mm and 4.13 mm in the FM and SA groups, respectively. Forward movement of the maxilla was similar between the groups. The vertical plane angle increased in both groups following maxillary protraction. However, it decreased in the SA group during fixed orthodontic therapy, which was contrary to what occurred in the FM group. The lower incisors were retracted/retroclined in the FM group and protracted/proclined in the SA group.

Conclusions/implications

Maxillary protraction was achieved in both groups and was maintained during fixed orthodontic therapy. Undesired lower incisor retraction and an increase of the vertical plane angle encountered with FM therapy were minimised by SA therapy.

Open Access

The association between chronological age, skeletal maturity and dental maturity

Published Online: 20 Jul 2021
Page range: 167 - 173

Abstract

AbstractAim

The aim of this study was to analyse the correlation between skeletal and dental maturity.

Materials and methods

The Dental Panoramic Tomogram and Lateral Skull Radiographs of 381 subjects aged between 8.20 years and 17.96 years were examined. Calcification stages of all the teeth on the left hand side and all third molars were determined according to Demirjians 8-stages, whilst the Cervical Vertebral Maturation (CVM) Index was adopted for the assessment of skeletal maturity. Dental age (DA) was determined using the simple weighted average method.

Results

There was no significant difference between DA and chronological age (CA) of the male and female groups. The Spearman rank correlation between CA and CVM was moderate, whilst the correlation between DA and CVM was weak. A moderate correlation was found between the dental calcification stages and CVM for the upper right third molar in males.

Conclusions

The average CA of females at every CVM stage was below that of males, confirming that females undergo earlier skeletal maturation. The similarity between CA and DA confirms that CA can be closely approximated by DA. The low correlations between CA and DA with CVM suggest that these variables should not be used in determining the growth status or potential of the individual.

Open Access

A survey of retention and retainer practices of orthodontists in Australia

Published Online: 20 Jul 2021
Page range: 174 - 183

Abstract

AbstractObjective

To survey retention and retainer practices of orthodontists in Australia.

Methods

A pilot-tested e-survey was distributed to 502 eligible members of the Australian Society of Orthodontists (ASO). The questions addressed participant background information, preferred retainer and retention practices, retainer characteristics and factors influencing retainer choice. Statistical analyses were performed using PASWH version 18.

Results

The response rate was 58%. Thermoplastic retainers (TRs) were the most commonly chosen retainer in the maxilla (39.4%) and bonded retainers (BRs) were most commonly chosen in the mandible (38.5%). An initial period of full-time wear of removable retainers (RRs) was prescribed by 37.7–48.3%. ‘Night/sleeping with reducing frequency over time’ was the most commonly prescribed part-time RR wear practice (28.1-33.5%).

Indefinite retainer wear was recommended by 85.3-87.4% of orthodontists. Indefinite retainer checks were carried out by 19.1-19.8% of orthodontists while 28.9-43.6% were ‘not happy’ for general dental practitioners (GDPs) to continue retention checks. Adjunctive retention practices were used by 25.6-72.8%. Pre-fabrication TR sheet thickness of 1.0 mm (68%) and polypropylene co-polymer/ethylene material type (55.8%) were most commonly used. Vacuum-forming was the preferred mode of TR fabrication by 48.4%. ‘Stainless steel single strand round’ was the most commonly used BR material type (33.4%). BR bonded to 12-22 (bonded to four teeth) was the most common BR design in the maxilla (48.8%) and 33-43 (bonded to six teeth) was most commonly chosen for the mandible (81.5%). Inadvertent tooth movement associated with BRs was observed by 62%. The orthodontist factor that most influenced retainer choice was the nature of the pretreatment malocclusion (88%).

Conclusion

Although there is agreement that retention is indefinite, orthodontic retention practices and retainer characteristics vary considerably between orthodontists in Australia. Greater communication between orthodontists and GDPs is required to effectively manage retention over the long term.

Open Access

The clinical benefits of orthodontic treatment to pathologically migrated teeth: A systematic review

Published Online: 20 Jul 2021
Page range: 184 - 194

Abstract

AbstractIntroduction

The present systematic review aimed to assess the evidence related to the periodontal benefits of orthodontic treatment of pathologically migrated teeth in combination with periodontal therapy with or without a regenerative procedure.

Methods

Electronic databases (PubMed, Embase and Cochrane) were searched up to March 21, 2019. Selection criteria included human studies in which pathologically migrated maxillary teeth were repositioned with orthodontic fixed appliances after periodontal therapy. Clinical trials not reporting a quantitative measurement of clinical attachment gain were excluded.

Results

The search strategy identified 90 relevant articles. After selection according to the inclusion/exclusion criteria, 15 articles qualified for the final analysis of which five were clinical trials and 10 were case series or reports. Five studies could be classified as providing a moderate level of evidence (33%), while 10 were classified as low levels of evidence (67%). None of the studies were classified as providing a high-level of evidence,

Conclusions

Based on the limited available evidence, orthodontic treatment had a fundamental role in the resolution of anterior pathologic tooth migration. Gains were seen in clinical attachment levels with accompanying improved aesthetic and functional final results. However, it was not possible to make any recommendations regarding the use of a specific regenerative procedure to improve the clinical results obtained by a combination of periodontal and orthodontic therapies. The most recurrent sources of bias were the absence of a control group and limited adequate examinations before and after treatment.

Open Access

Effectiveness of different psychological interventions in reducing fixed orthodontic pain: A systematic review and meta-analysis

Published Online: 20 Jul 2021
Page range: 195 - 209

Abstract

AbstractBackground/Objective

Pain induced by tooth movement is a common experience for orthodontic patients. The effectiveness of psychological intervention, as a new approach to control pain, has not been fully explored. Hence, this systematic review and meta-analysis is intended to evaluate the analgesic effect of psychological intervention within the week after fixed orthodontic initial arch wire placement.

Methods

A computerised literature search was conducted in the Medline (1966-2019), Embase (1984-2019), Cochrane Library (Issue 1 of 2019), CBMdisk (1978-2019) and CNKI (1994-2019) databases to identify randomised clinical trials (RCTs), which used psychological interventions to relieve pain during fixed orthodontic treatment. Specific inclusion and exclusion criteria were applied to identify relevant articles. The data were extracted independently by two reviewers and a quality assessment was carried out by using the Cochrane Collaboration ‘risk of bias’ tool. Meta-analyses were conducted with fixed or random effects models as appropriate. Statistical heterogeneity was also examined. The RevMan 5.3 software was used for data analysis.

Results

A total of 472 articles were identified, from which nine RCTs were finally included. A meta-analysis revealed that after initial arch wire placement, cognitive behaviour therapy (CBT) and music therapy could significantly reduce pain within three days compared with a control group. In addition, there were no differences in pain reduction between CBT and music therapy within one week. Furthermore, a structured phone and text follow-up could significantly reduce and control pain and had the same effectiveness in pain reduction.

Conclusions

In the short term after initial arch wire placement, all psychological interventions could significantly reduce the intensity of pain without adverse effects. In the current study, there was no significant difference in pain relief between the different psychological interventions. In the future, more high-quality research with consistency in research design is needed for further evaluation.

Open Access

Surgical repositioning of infra-occluded dental implants in the orthognathic management of a Class III open-bite patient

Published Online: 20 Jul 2021
Page range: 210 - 217

Abstract

Abstract

Dental implants placed in the maxillary anterior region have a high risk of aesthetic complications caused by later infra-occlusion and may subsequently require special therapeutic considerations to achieve optimal aesthetic and functional results. Based on the severity, possible treatment options for infra-occluded implants include replacement of the implant restoration, alveolar distraction osteogenesis, repositioning by a segmental osteotomy, or the removal of the implant. The present case report describes the successful application of bi-maxillary orthognathic surgery combined with an anterior segmental osteotomy for the correction of a Class III open-bite malocclusion complicated by severely infra-occluded implants.

Open Access

Retreatment of a skeletal Class II postpubescent patient with a convex facial profile and temporomandibular disorders

Published Online: 20 Jul 2021
Page range: 218 - 228

Abstract

AbstractObjectives

The present case report describes the orthodontic retreatment of a skeletal Class II postpubescent female patient who presented following previous orthodontic treatment that involved the extraction of the four first premolars, temporomandibular disorders and a convex facial profile.

Methods

The patient, aged 15 years, sought treatment for the chief complaints of an unaesthetic facial profile and difficulty in opening her mouth. The examination revealed a convex facial profile and a moderate skeletal Class II relationship within a long face. The patient had bilateral pain around the temporomandibular joints and her maximum mouth opening was only 11 mm. The treatment plan was to initially relieve the temporomandibular symptoms and then to retract the upper dentition using miniimplants.

Results

The patient’s mouth opening ability reached 37 mm and a significantly improved harmonious facial profile was achieved.

Conclusions

Cases that present with previous unsuccessful orthodontic treatment may be retreated to achieve a satisfactory aesthetic and functional result by precise control of tooth movement in three dimensions.

Open Access

An asymmetric magnetic reverse Twin-block applian ce for the treatment of a skeletal Class III malocclusion: a case report

Published Online: 20 Jul 2021
Page range: 229 - 240

Abstract

AbstractBackground

The treatment of a skeletal Class III malocclusion with accompanying mandibular asymmetry is an orthodontic challenge. A skeletal Class III may be associated with a retrognathic maxilla, a prognathic mandible and a mandibular asymmetry can be of dental or skeletal origin or in various combinations. Timely treatment with appropriate biomechanics is crucial for an acceptable and stable result.

Aims

The aim of this article was to introduce a clinically effective asymmetric magnetic reverse Twin-block appliance (AMRTB) for growth modification treatment of an 11-year-old girl who presented with a skeletal Class III malocclusion and accompanying mandibular asymmetry.

Methods

The treatment was comprised of two phases, the first of which was growth modification using the AMRTB for the stimulation of maxillary growth, restraint of mandibular growth, and improvement of the mandibular asymmetry. This was followed by a second phase involving full fixed appliances to optimise the interdigitation and occlusion.

Results

The skeletal Class III relationship and mandibular asymmetry was successfully corrected after two years of treatment. A good facial appearance and pleasing smile aesthetics were achieved. The treatment result was stable after six years of follow-up.

Conclusion

This case demonstrated that the AMRTB was a clinically effective appliance for growth modification treatment in patients with a skeletal Class III malocclusion and mandibular asymmetry.

14 Articles
Open Access

Reducing iatrogenic complications in the treatment of cleft lip and palate

Published Online: 20 Jul 2021
Page range: 110 - 118

Abstract

Abstract

All patients receiving orthodontic treatment with fixed appliances have a significantly higher risk of developing white spot lesions (WSLs), which are considered the most common iatrogenic complication of treatment.

Cleft lip and/or palate (CLP) is a common craniofacial anomaly occurring in approximately one in 800 births. Patients affected by cleft lip and/or palate tend to have poorer oral hygiene and a greater risk of WSLs and caries than non-cleft sibling controls. Patients presenting with a cleft lip and/or palate also have a higher prevalence of molar-incisor hypomineralisation (MIH), which suggests that clinicians involved in the oral health management of cleft patients need to consider all available caries prevention protocols.

Cases presenting with hypomineralised teeth create more difficulty in bonding attachments to affected enamel using an acid etch technique and a composite resin material due to the abnormal prism structure. The bond strength to hypomineralised enamel can be as low as two-thirds that of the bond strength to unaffected enamel, which may not be adequate for routine fixed appliance treatment. Furthermore, the removal of orthodontic brackets from hypomineralised enamel may lead to more severe damage to the affected teeth.

Resin modified glass-ionomer cement (RMGIC), bonded after conditioning the enamel with polyacrylic acid, creates no resin tags as a result of a chemical rather than a mechanical bond. Therefore, there is less enamel loss during bracket debonding when compared with acid-etch preparation and composite resin bonding.

Furthermore, in cases in which the quality of the enamel is deficient causing limits to the shear bond strength of the acid-etched composite resin, the chemical bonding action of RMGIC overcomes the lack of adherence and protects the enamel.

RMGIC has cariostatic properties and clinical evidence supports the routine use of these adhesives for bonding in all fixed appliance cases as a strategy for reducing the incidence of white spot lesions and damage to the enamel during bracket debonding.

Open Access

The impact of orthodontic treatment on the dental occlusion and oral health-related quality of life of individuals with cleft lip and/or palate

Published Online: 20 Jul 2021
Page range: 119 - 126

Abstract

AbstractBackground

Children with cleft lip and/or palate (CL/P) are a special group of orthodontic patients. Oral health-related quality of life (OHRQoL) is an important aspect of treatment outcome that is becoming popular in its application in orthodontics, but its relationship with clinical treatment outcomes remains unclear.

Objectives

To compare OHRQoL and clinical treatment outcomes of a sample of children with cleft lip and/or palate and non-cleft children before and after orthodontic treatment in order to determine whether there is an association between the two outcome measures.

Methods

A prospective observational longitudinal study was conducted of 60 consecutive adolescent patients (33 CL/P and 27 non-cleft) who received orthodontic treatment at Christchurch Hospital, New Zealand. The two outcome measures were a self-reported OHRQoL outcome assessed by the short form 8 item Child Perception Questionnaire (CPQ-ISF 8) and an orthodontic treatment outcome assessed by the Peer Assessment Rating (PAR) index.

Results

Both CL/P and non-cleft groups had comparable pretreatment malocclusion severity with similar baseline and end of treatment OHRQoL. Although both groups showed similar improvements in OHRQoL following orthodontic treatment, the non-cleft group had significantly greater improvement in their PAR outcome. There was no association detected between OHRQoL and the PAR improvement.

Conclusion

Both study groups had similar OHRQoL changes following orthodontic treatment despite the non-cleft group having better orthodontic treatment outcomes. There is a lack of correlation between the patient’s self-assessment OHRQoL and clinically based orthodontic treatment outcomes.

Open Access

Effect of combined oral contraceptives on orthodontic tooth movement in a female rat model

Published Online: 20 Jul 2021
Page range: 127 - 133

Abstract

AbstractBackground

To investigate the effect of combined oral contraceptives (COC) on orthodontic tooth movement (OTM) and periodontal remodelling in a female rat model.

Methods

A total of 80 three-month-old female, Sprague-Dawley rats were randomly divided into experimental and control groups. The maxillary first molars were moved mesially using nickel-titanium coil springs (50 g force). The experimental group (N = 40) ingested 1.5 ml COC (Marvelon, 0.12 mg/d, N.V. Organon, Oss, The Netherlands) daily. The control group (N = 40) ingested 1.5 ml saline (0.9% sodium chloride) daily. After 7, 14, 21 and 28 days of force application, 10 rats in each group were euthanased and a vernier calliper was used to measure the orthodontic movement of the first molar. Root resorption at pressure areas was assessed by H and E staining. Micro-CT was used to detect alveolar bone mineral density.

Results and conclusion

The amount of OTM in the experimental group (0.46 ± 0.16 mm) was significantly less than in the control group (0.85 ± 0.25 mm; p = 0.003) during the 28 days of observation. There were significantly smaller (p = 0.002) root resorption lacunae in the experimental group (111710 ± 4037 pixels) compared with the control group (204962 ± 21318 pixels) after 28 days. There was no statistically significant difference in the bone mineral density between the experimental and control groups throughout the study period (p > 0.05 at each time point). The short-term administration of COC may retard tooth movement and reduce the level of root resorption during OTM in female rats.

Open Access

The effect of head posture on facial soft tissue changes captured by white-light facial scanning

Published Online: 20 Jul 2021
Page range: 134 - 142

Abstract

AbstractObjective

To investigate whether changes in head posture have significant effects on facial soft tissues during white-light scanning.

Materials and methods

Thirty-four adult patients participated in the study in which 22 soft tissue landmarks were marked on the face of each subject using an oil-based pen. The subjects wore digital inclinometers on top of their heads, and sat relaxed with their heads orientated in natural head position (NHP), while a facial scan was captured. The subjects underwent a second facial scan in an upward 5°(U5), upward 10°(U10), downward 5°(D5), or a downward 10°(D10) direction with respect to the NHP. The NHP image was superimposed on the images taken at the different head postures and a single co-ordinate system was obtained. The axial reference plane (x-axis), the sagittal reference plane (y-axis) and the coronal plane (z-axis) were set with N’ as the zero point (0, 0, 0). The changes in position of each landmark caused by the change of head posture were measured.

Results

When the subject’s head was in the U5 and D5 posture, changes in landmark identification were not statistically significantly different. When the subject’s head was in the U10 posture, soft tissue Stmi and Li moved downward significantly. Soft tissue pogonion moved forward significantly in the D10 posture.

Conclusions

Soft tissue changes within 5° of the natural head posture were clinically negligible. If efforts to reproduce natural head position are carried out, reliable facial scanning images can be obtained without the support of any special head positioning tools.

Open Access

Evaluation of treatment risks and the quality of information contained within the websites of specialist orthodontists

Published Online: 20 Jul 2021
Page range: 143 - 151

Abstract

AbstractObjective

To evaluate the treatment risks and the quality of information contained within the websites of specialist orthodontists in Australia.

Methods

The term ‘specialist orthodontic practice’ was entered into three internet search engines. Websites satisfying inclusion and exclusion criteria were evaluated for orthodontic treatment risk information against nine common treatment risks. For website reliability and quality, the DISCERN instrument was used along with the HON (health on the net) seal certification; and for readability, the Flesch Reading Ease (FRE) Test was applied.

Results

Of the 105 websites that met the inclusion and exclusion criteria, 4.8% reported all nine risks. No risks were reported by 17.1%. Relapse (64.8%) was the most common risk recorded on websites, followed by ‘pain/discomfort’ (63.8%). Root resorption was reported by 5.7%. The requirement for life-long retention was indicated by 22.9% of the websites and 57.1% gave advice on sports mouthguard wear. The proposed benefits of orthodontic treatment were outlined by 85.7%. The mean (standard deviation [SD]) overall DISCERN score was 43.78 (SD 6.49; range 17–59). No website displayed the HON Seal certification. The mean FRE Score was 51.71 (SD 10.19; range 30.1–74.7).

Conclusions

Information regarding orthodontic treatment risks contained within specialist orthodontic practice websites appears deficient. Websites were of variable reliability, quality and readability. Further development of specialist orthodontists’ websites is required to ensure the delivery of accessible, reliable and understandable evidence-based information to patients.

Open Access

Interceptive orthodontic practices in general dentistry: a cross-sectional study

Published Online: 20 Jul 2021
Page range: 152 - 157

Abstract

AbstractObjectives

To evaluate the current practice of interceptive orthodontics undertaken by general dental practitioners and identify influencing factors.

Materials and methods

Printed questionnaires were provided to 200 registered Australian general dental practitioners. Participants were questioned about their current confidence, attitudes, and practice, related to interceptive orthodontics in general dentistry.

Results

The decision to practise interceptive orthodontics (17.4% of respondents) was strongly dependent on the confidence of the dentist (x2 = 48.693; df = 4; p < 0.001). It was also found that the provision of interceptive orthodontics was prevented by its perceived importance (x2 = 23.559; df = 5; p < 0.001) and benefit in a general dental setting (x2 = 9.411; df = 4; p = 0.035). The provision of more education was not shown to likely increase the number of dentists performing interceptive orthodontics. Low clinician confidence in the provision of interceptive orthodontics was also shown to result in orthodontic consultation prior to performing treatment (x2 = 31.782; df = 16; p = 0.004) or referral to an orthodontist (x2 = 42.465; df = 12; p < 0.001).

Conclusions

Interceptive orthodontics was not practised by most dentists. This decision was shown to be influenced by the clinicians’ confidence, further education or training, perceived importance of interceptive orthodontics and the impact that early intervention might have on future orthodontic treatment. Consideration should also be given to clarifying the orthodontic scope of practice for general dentists, in order to reduce the confusion influencing the provision of orthodontic care.

Open Access

Evaluation of skeletally anchored therapy using miniplates and micro-implants in skeletal Class III treatment

Published Online: 20 Jul 2021
Page range: 158 - 166

Abstract

AbstractBackground/aim

To compare the outcomes of skeletally-anchored (SA) or face mask (FM) therapy in the management of patients presenting with maxillary retrognathia.

Methods

Forty-four consecutively treated maxillary retrognathic patients who underwent SA or FM therapies followed by fixed orthodontics were evaluated. Two micro-implants between the maxillary first molar and the second premolar and two mandibular miniplates were inserted to facilitate the use of Class III elastics in the SA group (23 patients). Facemasks with full occlusal-coverage acrylic appliances were applied in the FM group (21 patients). Lateral cephalometric radiographs obtained before treatment (T0), after orthopaedic treatment (T1), and after fixed orthodontic treatment (T2) were traced and 31 measurements compared.

Results

No statistically significant differences were found between the groups related to treatment duration and gender distribution. The mean age was significantly higher in the SA group (11.70±0.25 years) compared with the FM group (10.57±0.35 years) at T0. The mean ANB angle increased by 3.34° and 3.15° and the mean Wits value reduced by 6.16 mm and 4.13 mm in the FM and SA groups, respectively. Forward movement of the maxilla was similar between the groups. The vertical plane angle increased in both groups following maxillary protraction. However, it decreased in the SA group during fixed orthodontic therapy, which was contrary to what occurred in the FM group. The lower incisors were retracted/retroclined in the FM group and protracted/proclined in the SA group.

Conclusions/implications

Maxillary protraction was achieved in both groups and was maintained during fixed orthodontic therapy. Undesired lower incisor retraction and an increase of the vertical plane angle encountered with FM therapy were minimised by SA therapy.

Open Access

The association between chronological age, skeletal maturity and dental maturity

Published Online: 20 Jul 2021
Page range: 167 - 173

Abstract

AbstractAim

The aim of this study was to analyse the correlation between skeletal and dental maturity.

Materials and methods

The Dental Panoramic Tomogram and Lateral Skull Radiographs of 381 subjects aged between 8.20 years and 17.96 years were examined. Calcification stages of all the teeth on the left hand side and all third molars were determined according to Demirjians 8-stages, whilst the Cervical Vertebral Maturation (CVM) Index was adopted for the assessment of skeletal maturity. Dental age (DA) was determined using the simple weighted average method.

Results

There was no significant difference between DA and chronological age (CA) of the male and female groups. The Spearman rank correlation between CA and CVM was moderate, whilst the correlation between DA and CVM was weak. A moderate correlation was found between the dental calcification stages and CVM for the upper right third molar in males.

Conclusions

The average CA of females at every CVM stage was below that of males, confirming that females undergo earlier skeletal maturation. The similarity between CA and DA confirms that CA can be closely approximated by DA. The low correlations between CA and DA with CVM suggest that these variables should not be used in determining the growth status or potential of the individual.

Open Access

A survey of retention and retainer practices of orthodontists in Australia

Published Online: 20 Jul 2021
Page range: 174 - 183

Abstract

AbstractObjective

To survey retention and retainer practices of orthodontists in Australia.

Methods

A pilot-tested e-survey was distributed to 502 eligible members of the Australian Society of Orthodontists (ASO). The questions addressed participant background information, preferred retainer and retention practices, retainer characteristics and factors influencing retainer choice. Statistical analyses were performed using PASWH version 18.

Results

The response rate was 58%. Thermoplastic retainers (TRs) were the most commonly chosen retainer in the maxilla (39.4%) and bonded retainers (BRs) were most commonly chosen in the mandible (38.5%). An initial period of full-time wear of removable retainers (RRs) was prescribed by 37.7–48.3%. ‘Night/sleeping with reducing frequency over time’ was the most commonly prescribed part-time RR wear practice (28.1-33.5%).

Indefinite retainer wear was recommended by 85.3-87.4% of orthodontists. Indefinite retainer checks were carried out by 19.1-19.8% of orthodontists while 28.9-43.6% were ‘not happy’ for general dental practitioners (GDPs) to continue retention checks. Adjunctive retention practices were used by 25.6-72.8%. Pre-fabrication TR sheet thickness of 1.0 mm (68%) and polypropylene co-polymer/ethylene material type (55.8%) were most commonly used. Vacuum-forming was the preferred mode of TR fabrication by 48.4%. ‘Stainless steel single strand round’ was the most commonly used BR material type (33.4%). BR bonded to 12-22 (bonded to four teeth) was the most common BR design in the maxilla (48.8%) and 33-43 (bonded to six teeth) was most commonly chosen for the mandible (81.5%). Inadvertent tooth movement associated with BRs was observed by 62%. The orthodontist factor that most influenced retainer choice was the nature of the pretreatment malocclusion (88%).

Conclusion

Although there is agreement that retention is indefinite, orthodontic retention practices and retainer characteristics vary considerably between orthodontists in Australia. Greater communication between orthodontists and GDPs is required to effectively manage retention over the long term.

Open Access

The clinical benefits of orthodontic treatment to pathologically migrated teeth: A systematic review

Published Online: 20 Jul 2021
Page range: 184 - 194

Abstract

AbstractIntroduction

The present systematic review aimed to assess the evidence related to the periodontal benefits of orthodontic treatment of pathologically migrated teeth in combination with periodontal therapy with or without a regenerative procedure.

Methods

Electronic databases (PubMed, Embase and Cochrane) were searched up to March 21, 2019. Selection criteria included human studies in which pathologically migrated maxillary teeth were repositioned with orthodontic fixed appliances after periodontal therapy. Clinical trials not reporting a quantitative measurement of clinical attachment gain were excluded.

Results

The search strategy identified 90 relevant articles. After selection according to the inclusion/exclusion criteria, 15 articles qualified for the final analysis of which five were clinical trials and 10 were case series or reports. Five studies could be classified as providing a moderate level of evidence (33%), while 10 were classified as low levels of evidence (67%). None of the studies were classified as providing a high-level of evidence,

Conclusions

Based on the limited available evidence, orthodontic treatment had a fundamental role in the resolution of anterior pathologic tooth migration. Gains were seen in clinical attachment levels with accompanying improved aesthetic and functional final results. However, it was not possible to make any recommendations regarding the use of a specific regenerative procedure to improve the clinical results obtained by a combination of periodontal and orthodontic therapies. The most recurrent sources of bias were the absence of a control group and limited adequate examinations before and after treatment.

Open Access

Effectiveness of different psychological interventions in reducing fixed orthodontic pain: A systematic review and meta-analysis

Published Online: 20 Jul 2021
Page range: 195 - 209

Abstract

AbstractBackground/Objective

Pain induced by tooth movement is a common experience for orthodontic patients. The effectiveness of psychological intervention, as a new approach to control pain, has not been fully explored. Hence, this systematic review and meta-analysis is intended to evaluate the analgesic effect of psychological intervention within the week after fixed orthodontic initial arch wire placement.

Methods

A computerised literature search was conducted in the Medline (1966-2019), Embase (1984-2019), Cochrane Library (Issue 1 of 2019), CBMdisk (1978-2019) and CNKI (1994-2019) databases to identify randomised clinical trials (RCTs), which used psychological interventions to relieve pain during fixed orthodontic treatment. Specific inclusion and exclusion criteria were applied to identify relevant articles. The data were extracted independently by two reviewers and a quality assessment was carried out by using the Cochrane Collaboration ‘risk of bias’ tool. Meta-analyses were conducted with fixed or random effects models as appropriate. Statistical heterogeneity was also examined. The RevMan 5.3 software was used for data analysis.

Results

A total of 472 articles were identified, from which nine RCTs were finally included. A meta-analysis revealed that after initial arch wire placement, cognitive behaviour therapy (CBT) and music therapy could significantly reduce pain within three days compared with a control group. In addition, there were no differences in pain reduction between CBT and music therapy within one week. Furthermore, a structured phone and text follow-up could significantly reduce and control pain and had the same effectiveness in pain reduction.

Conclusions

In the short term after initial arch wire placement, all psychological interventions could significantly reduce the intensity of pain without adverse effects. In the current study, there was no significant difference in pain relief between the different psychological interventions. In the future, more high-quality research with consistency in research design is needed for further evaluation.

Open Access

Surgical repositioning of infra-occluded dental implants in the orthognathic management of a Class III open-bite patient

Published Online: 20 Jul 2021
Page range: 210 - 217

Abstract

Abstract

Dental implants placed in the maxillary anterior region have a high risk of aesthetic complications caused by later infra-occlusion and may subsequently require special therapeutic considerations to achieve optimal aesthetic and functional results. Based on the severity, possible treatment options for infra-occluded implants include replacement of the implant restoration, alveolar distraction osteogenesis, repositioning by a segmental osteotomy, or the removal of the implant. The present case report describes the successful application of bi-maxillary orthognathic surgery combined with an anterior segmental osteotomy for the correction of a Class III open-bite malocclusion complicated by severely infra-occluded implants.

Open Access

Retreatment of a skeletal Class II postpubescent patient with a convex facial profile and temporomandibular disorders

Published Online: 20 Jul 2021
Page range: 218 - 228

Abstract

AbstractObjectives

The present case report describes the orthodontic retreatment of a skeletal Class II postpubescent female patient who presented following previous orthodontic treatment that involved the extraction of the four first premolars, temporomandibular disorders and a convex facial profile.

Methods

The patient, aged 15 years, sought treatment for the chief complaints of an unaesthetic facial profile and difficulty in opening her mouth. The examination revealed a convex facial profile and a moderate skeletal Class II relationship within a long face. The patient had bilateral pain around the temporomandibular joints and her maximum mouth opening was only 11 mm. The treatment plan was to initially relieve the temporomandibular symptoms and then to retract the upper dentition using miniimplants.

Results

The patient’s mouth opening ability reached 37 mm and a significantly improved harmonious facial profile was achieved.

Conclusions

Cases that present with previous unsuccessful orthodontic treatment may be retreated to achieve a satisfactory aesthetic and functional result by precise control of tooth movement in three dimensions.

Open Access

An asymmetric magnetic reverse Twin-block applian ce for the treatment of a skeletal Class III malocclusion: a case report

Published Online: 20 Jul 2021
Page range: 229 - 240

Abstract

AbstractBackground

The treatment of a skeletal Class III malocclusion with accompanying mandibular asymmetry is an orthodontic challenge. A skeletal Class III may be associated with a retrognathic maxilla, a prognathic mandible and a mandibular asymmetry can be of dental or skeletal origin or in various combinations. Timely treatment with appropriate biomechanics is crucial for an acceptable and stable result.

Aims

The aim of this article was to introduce a clinically effective asymmetric magnetic reverse Twin-block appliance (AMRTB) for growth modification treatment of an 11-year-old girl who presented with a skeletal Class III malocclusion and accompanying mandibular asymmetry.

Methods

The treatment was comprised of two phases, the first of which was growth modification using the AMRTB for the stimulation of maxillary growth, restraint of mandibular growth, and improvement of the mandibular asymmetry. This was followed by a second phase involving full fixed appliances to optimise the interdigitation and occlusion.

Results

The skeletal Class III relationship and mandibular asymmetry was successfully corrected after two years of treatment. A good facial appearance and pleasing smile aesthetics were achieved. The treatment result was stable after six years of follow-up.

Conclusion

This case demonstrated that the AMRTB was a clinically effective appliance for growth modification treatment in patients with a skeletal Class III malocclusion and mandibular asymmetry.

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