231 research outputs found
“I Will Rise Again”: The Life and Legacy of the U.S.S. Monitor
No full textAbout the author:
Declan Riley Kunkel is an award winning writer, author, and consultant. Originally from Fort Worth, Texas, Declan writes about history, politics, and philosophy. He is pursing a degree in history at Yale
Interproximal reduction in orthodontics: a survey of specialist orthodontists and patients
No full textAIMS:
[1] To assess interproximal reduction (IPR) practices of specialist orthodontists in the Republic of Ireland (RoI).
[2] To evaluate patient perceptions of IPR as part of orthodontic treatment.
SUBJECTS AND METHODS: Ethical approval was granted by the Cork Teaching Hospitals Clinical Research Ethics Committee. Orthodontists on the Irish Dental Council’s specialist register and consecutive patients receiving IPR in Cork University Dental School and Hospital’s Postgraduate Orthodontic Unit were surveyed. Two de novo questionnaires were developed, pre-tested, piloted and distributed either electronically or by post to orthodontists and completed in-person by patients. Data with respect to demographic details, IPR use and technique employed, as well as patient perception were collected in the orthodontist survey. The patient survey collected demographic details, knowledge and perceptions of IPR. Descriptive statistics, Chi-squared tests, two-sample test comparison of means and correlation coefficients were used in analyses, with significance set at p≤0.05. Thematic analysis was performed independently by two assessors for qualitative questions in the Patient Questionnaire.
RESULTS: Responses were received from 105 specialists (75%). Nearly all (98%) performed IPR, 44% reported increased use in the past five years. Handheld strips were most popular (37%), followed by burs (17%). Instrument use in postgraduate training was associated with subsequent use in practice (p<0.001 for abrasive strips in a holder; p=0.003 for burs). Lower labial segment teeth were most frequently reduced. IPR was most often employed with aligners (59%), pre-adjusted edgewise (33%) and self-ligating appliances (30%). Adult patients, followed by adolescents in the permanent dentition were most likely to be prescribed IPR, for the purposes of reshaping triangular teeth or restorations, resolving mild crowding and addressing tooth-size discrepancies or black triangles. Enamel removal, typically 0.3mm per surface anteriorly and 0.4mm per surface posteriorly, created 2-4mm of space in each arch (60%) and was done in <5 minutes (45%) over multiple visits (82%) without routinely recontouring, polishing or treating the teeth afterwards. Written information was not given (90%) and only 12% reported prior patient awareness of IPR. Pain was the most common risk discussed, although reported patient perception of pain (9%) was less than for discomfort (48%) with 71% indicating patient preference of IPR over extractions.
Thirty patients (13 males and 17 females, mean age 16.2 ± 1.75 years) completed the questionnaire. Few (17%) had heard of IPR, but all reported understanding after explanation. Most (93%) ‘did not mind’ having IPR, 37% regarded it as ‘uncomfortable’ and 13% ‘painful’ (mean 2.3/10 on a visual analogue scale) and all would prefer IPR to extraction. Themes patients would tell a friend or family member about IPR were: pain, discomfort, comparison to extraction, speed, benefits, bleeding and side effects but would reassure and recommend the procedure.
CONCLUSIONS:
[1] Specialist orthodontists in RoI routinely performed IPR using handheld strips, mostly in the lower labial segment of the adult or adolescent permanent dentition, as part of aligner or fixed appliance treatment to reshape triangular teeth or restorations, resolve mild crowding and address tooth-size discrepancies or black triangles.
[2] Conservative enamel reduction of <0.5mm per surface, creating 2-4mm of space per arch, in <5 minutes over multiple visits without subsequently polishing, recontouring or treating enamel was most commonly adopted.
[3] Patients were rarely given written information on IPR, were perceived by orthodontists to be unfamiliar with IPR prior to treatment, found the procedure uncomfortable rather than painful and preferable to extractions.
[4] Patients themselves were unfamiliar with IPR but found it easy to understand, did not mind having IPR done, found it uncomfortable rather than painful, expressed a preference for IPR over extraction and would provide mostly positive feedback on the procedure to others
Children and adolescents and modified twin block for Class II division 1 malocclusion compared to controls: quantitative and qualitative analyses
No full textAims
• To evaluate the impact Modified Twin Block (MTB) treatment has on oral health related quality of life (OHRQoL), self-esteem, self-perception of aesthetic treatment need and 3D soft tissue facial changes in children with Class II division 1 malocclusion (II/1M) compared to children with II/1M awaiting treatment who served as controls.
• To assess the effect MTB treatment has on family quality of life (QoL) and on both the parent’s perception of their child’s OHRQoL and aesthetic treatment need compared to controls.
• To assess the level of agreement of child OHRQoL and perception of aesthetic treatment need by child and parent between groups.
Materials and methods
Following ethical approval, 60 subjects (31 males; 29 females) received MTB treatment (MTB group) and 47 subjects (22 males; 25 females) with II/1M awaiting treatment served as controls (Control group). At baseline (T1) and following MTB treatment/recall (T2) all subjects completed the Child Perception Questionnaire (CPQ11-14), Child Health Questionnaire short from (CHQ-CF45) and self-assessed aesthetic treatment need (IOTN-AC). Each child also had a 3D facial image captured at rest. At the same time points, a parent of each child completed the Parent-Caregiver Perception Questionnaire (P-CPQ) and assessed their child’s aesthetic treatment need (IOTN-AC). Comparisons of patient demographics were made using ANOVA and Chi-square tests. ANOVA was used for comparisons in CPQ, P-CPQ, CHQ-CF45 and 3D soft tissue facial changes at T1 and T2 between groups and paired t-tests were used within both groups. Bowker’s symmetry test was used to compare IOTN-AC within groups and Fisher’s Exact test was used between groups. ANOVA was used to test for associations between CPQ, CHQ, IOTN-AC, and 3D soft tissue facial change.
Results
Forty-two subjects (20 males; 22 females) completed MTB treatment (average duration 8.5 months; range 5-12 months) and 35 untreated II/1M subjects (15 males; 20 females) were recalled after an average time of 11 months (range 9-13 months). At T1, groups were similar in age (p=0.1402) and gender (p=0.2973) but overjet in the MTB group was slightly greater (p=0.0016). At T2, there was a significant improvement in the MTB group in overall OHRQoL (p<0.0001) and self-perception of aesthetic treatment need (p=0.018) but there was no change in self-esteem (p=0.144). Significant improvements occurred in family QoL (p=0.0001), in parent’s perception of both their child’s OHRQoL (p<0.0001) and aesthetic treatment need (p<0.0001). In the MTB and Control groups and at both time points, the level of agreement between child and parent perception of the child’s OHRQoL was poor with parents rating it worse [MTB group T1, p=0.0001; T2, p=0.003]; [Control group T1, p=0.001; T2, p=0.008]. At T1, parents rated the aesthetic treatment need to be greater than their child in the MTB group (p=0.054) and Control group (p=0.04). At T2, the level of agreement between the child and parent in their aesthetic treatment need was similar (p=0.262) but in the MTB group children perceived their aesthetic treatment need to be greater than their parents (p=0.019). From T1 to T2, significant 3D soft tissue changes occurred at Pogonion in the MTB group 4.26 mm (p= 0.001) and in the Control group 3.29 mm (p=0.002) but the mean difference between the groups (0.97 mm; p=0.011) was not clinically significant.
Conclusions
• MTB treatment significantly improved the OHRQoL and self-perception of aesthetic treatment need in children with II/1M but had no significant impact on self-esteem or 3D soft tissue facial changes compared to controls.
• MTB treatment significantly improved the family QoL and both the parent’s perception of their child’s OHRQoL and aesthetic treatment need compared to controls.
• In children following MTB treatment or awaiting treatment, poor agreement existed between the child and parent perception of OHRQoL and aesthetic treatment need
Psychosocial and physiological assessments of orthognathic patients
No full textAims: The primary aim was to compare, in the RoI, generic oral health-related quality of life (OHIP14), condition-specific quality of life (OQLQ), the fear of negative evaluation (BFNES) and self-reported BMI of patients seeking surgical-orthodontic correction of their malocclusion versus those of the general population. A secondary aim was to assess the IOFTN in the orthognathic cohort and to investigate any correlation between the functional domain of OQLQ and IOFTN. Materials and Methods: Orthognathic patients prior to commencing pre-surgical orthodontics from five regional HSE orthodontic units within the RoI and randomly selected age-matched subjects from the general population were invited to complete a telephone interview. Participants were asked questions regarding general characteristics and then asked to respond to the validated questionnaires OHIP-14, OQLQ, and BFNES. IOFTN grades of the orthognathic sample were also assessed. Results: Eighty orthognathic patients (39 males; 41 females) with an overall mean age of 17.5 (SD 1.6) years and 213 subjects from the general population (95 males; 118 females) with an overall mean age of 17.8 (SD 1.5) years completed a telephone interview. Orthognathic patients had significantly higher mean scores for OHIP-14, OQLQ and S-BFNES than the general population (p < 0.001). The mean score of OHIP-14 for the orthognathic patients and the general population were 14 (SD 8.6) and 5 (SD 5.9) respectively. Corresponding group scores for OQLQ were 40.9 (SD 19.3) and 19.9 (SD 14.9), and for S-BFNES were 23.2 (SD 7.2) and 18.8 (SD 8.1). Females had higher overall OQLQ and S-BFNES scores than males in both groups (p < 0.0001). There was no significant difference in the distribution of self-reported BMI categories between the groups (p = 0.8931). More than 90 per cent of the orthognathic sample were in IOFTN grade 4 and grade 5 showing ‘great’ and ‘very great’ functional need for surgery respectively. No association was found between the functional domain of OQLQ and IOFTN categories (p=0.5530). Conclusion: Orthognathic patients reported significantly poorer oral-health related and condition-specific quality of life as well as higher levels of social anxiety than the general population. Females in both groups had higher scores than males for OQLQ and S-BFNES. There was no correlation between the functional domain of OQLQ and IOFTN
Personal experiences and social perception of a modified twin block appliance
No full textAims • To evaluate patient experiences over the first 6 months of Modified Twin Block Appliance (MTBA) treatment for the correction of Class II division 1 malocclusion. • To investigate whether social judgements are made by peers of patients with Class II division 1 malocclusion with and without an MTBA. Materials and methods • Following ethical approval, 50 children, with Class II division 1 malocclusion (overjet greater than 7 mm) were recruited. Treatment was undertaken with an MTBA and the children were followed up for 6 months. Two validated questionnaires were completed at prescribed time-points. One questionnaire recorded pain and discomfort scores; the second questionnaire, the Child Perception Questionnaire (CPQ), assessed the impact treatment with an MTBA had on the child’s OHRQoL. Statistical analysis was performed using SAS (Version 9.4) • Following ethical approval, a cross-sectional questionnaire study was conducted on 461 children from 30 randomly selected primary schools in Cork City and County. Each child was randomly assigned one full face smiling photograph of a boy or girl, with or without an MTBA in situ. Children were asked to make judgements concerning the subject’s social competence (SC), psychosocial adjustment (PA) and intellectual ability (IA). Four point Likert scales were used to record their opinions. Statistical analyses were performed using SAS (Version 9.4) Results • After fitting an MTBA, mean pain scores peaked in the incisors in the first 2 days, lip and soft tissue pain peaked on day 2, with the former greater than the latter. Discomfort in the jaws peaked on day 1. Over a 6 month period, the mean levels of pain and discomfort reported after fitting of an MTBA were mild. The frequency of headaches was lower after 6 months of MTBA treatment than before fitting the MTBA. • The mean CPQ scores were highest at the 6 week time-point (p=0.0155) in the OS, FL, SWB domains. Patients who reported wearing the MTBA full time (p=0.0070) or full time except while eating (p=0.0288) had lower CPQ scores than those with poor compliance. The larger the pre-treatment overjet, the greater the CPQ scores in the EWB and SWB domains (p=0.0258 and p=0.0458) respectively. • There was no significant difference between social competence (SC) (p=0.2614), psychosocial ability (PA) (p=0.6890), and intellectual ability (IA) (p=0.2564) for the presence or absence of an MTBA. For SC, 11 year old children gave a more positive rating than 12 year old children when the child in the photograph was male. For PA and IA, females tended to give more positive ratings than males, particularly when the child in the photograph was male. Conclusions • After fitting an MTBA, peak dental and soft tissue pain was experienced on day 1 and day 2 respectively. • Peak discomfort in the teeth and jaws occurred on the evening of fit and decreased after day 1. In general over the first 6 months after fitting an MTBA mean pain and discomfort levels in the teeth, soft tissues and jaws were mild. • MTBA wear had its greatest impact on OHRQoL at 6 weeks and those with good compliance had overall better OHRQoL than those with poor compliance. • Social perceptions of children do not differ in the presence or absence of an MTBA
Comparison of statural height growth velocity with chronological age and dental development at different cervical vertebral maturation stages in a contemporary Irish population
No full textAim:
The aim of this study was to investigate if a correlation exists between CVM stage and statural height growth velocity, chronological age and dental development in a contemporary Irish population.
Materials and Methods:
Following ethical approval, a total of 269 subjects were recruited from the orthodontic treatment waiting list at Cork University Dental School and Hospital (CUDSH). All participants had a digital lateral cephalogram and DPT as part of their initial orthodontic records. Standardised standing height was also measured at this initial appointment and at subsequent 6 to 8 week intervals for approximately one year to calculate a mean annualised growth velocity (MAGV). A single calibrated observer assessed CVM stage from lateral cephalograms using the method described by Baccetti et al., (2005) and dental development stage of the mandibular second permanent molar from each DPT using Demirjian’s Index. Chronological age was determined from the subject’s chart. Statistical analysis of MAGV, chronological age and stage of dental development were performed using ANOVA, with CVM and gender as factors. Pairwise comparisons were made between CVM stages.
Results:
The final sample comprised of 218 subjects (121 females, 97 males), with a mean age of 14.02 (SD 1.97) years and age range of 8.82-18.77 years. Intra-observer (ĸ = 0.97) and inter-observer (ĸ = 0.94) reliability of CVM stage assessment were ‘almost perfect’. Intra-observer reliability for dental development stage was also ‘almost perfect’ (ĸ = 0.97). There was a statistically significant difference in MAGV between CVM stages (p<0.0001) and between genders (p<0.0001). The peak in statural height growth velocity occurred at CVM stage 3 in both males (mean age 13.39 (SD 0.75) years) and females (mean age 11.95 (SD 0.82) years). Chronological age exhibited significant differences between CVM stages (p<0.0001) and between genders (p<0.0001). There was also a statistically significant difference in the distribution of dental development stage between CVM stages (p<0.0001) and between genders (p=0.0292).
Conclusions:
• MAGV differed significantly between successive CVM stages in both males and females, with the peak in statural height growth velocity found at CVM stage 3.
• Chronological age differed significantly between CVM stages, and these differences were dependent on gender.
• The distribution of dental development stages differed significantly between CVM stages and between genders
Magnitude and reproducibility of smiling in 12-year-old Caucasian children in the Republic of Ireland: a comparison of Class I and Class II malocclusions
No full textAims:• To determine if malocclusion (Class I, Class II division 1 and Class II division 2) influences the magnitude, the immediate intra-session and the short-term inter-session reproducibility of the rest position to posed smile and the rest position to maximal smile. • To determine if gender influences the magnitude, the immediate intra-session and the short-term inter-session reproducibility of the rest position to posed smile and the rest position to maximal smile. Materials and Methods: One hundred and ten Caucasian volunteers (55 males; 55 females) aged 12 years, with no previous history of orthodontic treatment, identifiable syndrome or facial asymmetry, were recruited. Three malocclusion categories were assessed: Class I (20 males, 20 females), Class II division 1 (20 males; 20 females) and Class II division 2 (15 males; 15 females). Three-dimensional (3D) images of three facial expressions (rest position, posed smile and maximal smile) of each subject were captured using the Di3D system. These images were repeated 15 minutes later to assess immediate intra-session reproducibility and two weeks later to assess short-term inter-session reproducibility. Twenty-six landmarks were digitally placed on all the images. Landmark identification error was assessed by re-landmarking 10 percent of the images, one month after initial landmarking. The magnitude of movement from rest to posed smile and from rest to maximal smile averaged over all the landmarks was calculated for each session. Results: The magnitude of mean movement averaged over all the landmarks differed significantly between rest to posed smile and rest to maximal smile (p < 0.0001). This difference was found in both genders (p = 0.0012) but was greater in males than in females (p <0.0001). Immediate intra-session reproducibility (p=0.1677) was high for both rest to posed smile and rest to maximal smile. A statistically significant difference (p <0.0001) of 0.27mm in short-term inter-session reproducibility was found for both rest to posed smile and rest to maximal smile. This was, however, clinically insignificant. Malocclusion had no effect on magnitude of either smile (p = 0.8138) or immediate intra-session reproducibility (p = 0.3878) or short-term inter-session reproducibility (p=0.3396). Similar results were found when the 10 lower-face landmarks were assessed independently. Conclusion Rest to posed smile and rest to maximal smile differed in terms of magnitude of movement for both genders with males displaying a greater difference. The rest to posed smile and rest to maximal smile demonstrated immediate intra-session and short-term inter-session reproducibility in males and females. Malocclusion had no effect on the magnitude or reproducibility of smiling
Adolescent and parent perceptions of expected benefits of orthodontic treatment: a mixed-methods study
No full textAims:
1: To investigate expected benefits of orthodontic treatment from both an adolescent and parent perspective.
2: To rank the expected benefits of orthodontic treatment identified by adolescents and parents in order of perceived importance.
Materials and Methods:
Ethical approval was granted to carry out both parts of this study.
Part 1 used qualitative methodology with one-to-one semi-structured interviews by a trained interviewer. Twenty adolescents (10 males; 10 females) referred for orthodontic assessment and their parents (8 males; 12 females) were interviewed independently to explore expectations of the benefits of orthodontic treatment. Interviews were transcribed verbatim and interpretive phenomenological analysis carried out.
Part 2 quantitatively assessed the benefits identified in Part 1. Twelve additional adolescents (6 males; 6 females) who were referred for orthodontic assessment and a parent (6 males; 6 females), completed a card ranking exercise to determine the rank order of the perceived importance of each benefit. The mean rank was then calculated and a two-sample t-test, with the level of significance set at P < 0.05, used to determine if a difference existed between adolescents and parents for the mean rank of any of the expected benefits.
Results:
The expected benefits of orthodontic treatment from both adolescent and parent perspectives included 11 benefits which could be grouped into four categories: oral health (improved appearance of teeth; ease of maintaining good oral health; improved jaw alignment; aiding dental development), psychosocial (improved self-confidence; improved perception of dental appearance by others), functional (improved ability to chew food; improved speech) and behavioural change (improved oral hygiene habits; improved diet; cessation of bad habits). Adolescents and parents placed a similar level of importance on these benefits with “improved self-confidence” ranked highest and “improved speech” ranked lowest. The only benefit where the mean rank differed significantly between adolescents and parents was “improved ability to chew food” (two-sample t-test; P = 0.042) which was ranked higher by adolescents.
Conclusions:
Adolescents and parents perceived 11 expected benefits from orthodontic treatment affecting oral health, psycho-social, functional and behavioural categories.
Adolescents and parents ranked the expected benefits similarly with psycho-social ranked highest. Within functional benefits, speech improvement was ranked lowest by both but improved masticatory function was ranked of significantly greater importance by adolescents
The immediate effects of aligners and aesthetic fixed appliances on smiling and perceptions in young adults
No full textAIMS • To evaluate, in young adults, the immediate effect of clear aligners (CAs) and aesthetic fixed appliances (AFAs) on the magnitude of rest to natural and rest to maximal smile • To evaluate, in young adults, the immediate effect of CAs and AFAs on intra-session reproducibility of rest to natural and rest to maximal smile • To evaluate, in young adults, the immediate perception of CAs and AFAs MATERIALS AND METHODS Forty Caucasian subjects (20 females, 20 males), aged between 18 and 25 years, with a Class I incisor relationship and no history of orthodontic treatment were recruited. 3D stereophotogrammetric images were captured of each subject without appliances and separately, in random order with either CAs or AFAs (Session 1), at rest, natural and maximum smile (Capture A). Following a rest period of 15 minutes, the images were retaken both without and with appliances (Capture B) to assess intra-session reproducibility. Four weeks later (Session 2), the same protocol was adopted as per Session 1, except that subjects who had been randomised to the CAs were allocated to the AFAs and vice versa. All images had 26 landmarks placed by 1 operator. The landmarking identification error was calculated by re-landmarking 10 percent of the original sample one month after initial images were landmarked and determining the difference in landmark placement. The mean magnitude of movement and reproducibility with each expression, rest to natural and rest to maximal smile, were compared and analysed across both genders. Four weeks after Session 2, a questionnaire was issued via email to all subjects to evaluate the immediate perception of CAs and AFAs. RESULTS The landmark identification error was 0.50 +/- 0.08 mm. For rest to natural smile, there was no significant difference in magnitude of movement with and without CAs (p = 0.6964). In contrast, for rest to maximal smile, the magnitude of movement differed significantly with and without CAs (p = 0.0001), with significantly greater movement recorded with the latter. For rest to natural and rest to maximal smile, there was a significant difference in magnitude of movement with and without AFAs (p = 0.0024 and p = 0.0002 respectively). Significantly greater mean movement occurred with AFAs, than with CAs, for both expressions. The mean magnitude for each smile was greater in males than in females (p = 0.0109). The order of randomisation of appliances made no difference to the mean magnitude of movement from rest to natural and rest to maximal smile (p = 0.0939). Without appliances, there was no significant difference in intra-session reproducibility of the magnitude of rest to natural and rest to maximal smile (p = 0.3601) but significant differences existed in intra-session reproducibility of the mean magnitude of each expression with appliances (p = 0.0290). Although statistically significant differences were recorded between appliances in magnitude and intra-session reproducibility for both expressions, these are unlikely to be of any clinical significance. Seventy-six percent of subjects preferred CAs to AFAs as they were deemed to be more discrete (43 percent) and more comfortable (33 percent). All subjects indicated the appearance of CAs was good or very good. Ninety percent of subjects indicated that they were likely or very likely to recommend CAs. CONCLUSIONS • Except for rest to natural smile with CAs, both appliances had an immediate and significant impact on the mean magnitude of movement for both expressions • CAs and AFAs had a significant immediate effect on intra-session reproducibility of rest to natural and rest to maximal smile • Young adults’ immediate perception was preference for CAs as they were reckoned to be more discrete and comfortable
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