Orthodontics - A Quarterly Newsletter on Dental SpecialtiesJADA Specialty Scan

Orthodontic treatment and job prospects

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People with ideal smiles are considered more intelligent and have a greater chance of finding a job than people who have non-ideal smiles, according to new research.

Understanding that attractive people often are assigned desirable characteristics including greater ability, responsibility and social acuity, researchers publishing in the October 2014 issue of the American Journal of Orthodontics and Dentofacial Orthopedics asked, “Would dental esthetics have an influence on finding a job?”

Finding no evidence in the literature focusing on the question, they designed a study to assess whether dental esthetics would have an influence on the perceptions of human resources personnel.

To investigate, they selected 10 patients who needed orthodontic treatment and photographed them before treatment. Images of the subjects were manipulated to create ideal smiles. Two different questionnaires containing the photos of all 10 subjects were prepared — one with the photographs unaltered and the other with images showing subjects with orthodontic correction. Two subjects’ images were used as controls, one appearing as uncorrected and the other as corrected in each of the two questionnaires to evaluate the reliability of evaluators’ responses.

Each of 100 adults who were responsible for hiring and had a degree in business administration received one of the two questionnaires for evaluation. The images were accompanied by the following four questions:

Evaluators assigned more intelligence and greater likelihood of being hired to the photographs of people with ideal dental esthetics than the same subjects with non-ideal dental esthetics. Significant differences in evaluators’ perceptions of honesty and efficiency were not found.

http://www.ncbi.nlm.nih.gov/pubmed/25263144

 

Consulting Editor: Lee W. Graber, DDS, MS, MS, PhD
Diplomate, American Board of Orthodontics

Early and late stage treatment outcomes explored

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The September 2014 issue of Angle Orthodontist includes a systematic review on the most favorable time for starting orthodontic treatment in patients with severe crowding that is caused by significant tooth size arch length deficiency (TSALD).

Severe TSALD can be treated in the mixed dentition with serial primary and permanent tooth extractions or in its later stage with extraction of the premolars in the permanent dentition. Either way, the goal of is to create space to enable the correct alignment and leveling of the teeth in bone.

Oft discussed factors favoring mixed dentition “early” extraction treatment are that it is easy to perform and its cost, duration and stability are better vs. later treatment. Scientists at the Universidade Federal do Rio de Janiero Dental School noted, however, that the optimism about early treatment was based on professional experience and case reports. They aimed to investigate the body of evidence about the most favorable time for initiating orthodontic treatment in such cases by means of a systematic review to answer the following focused question: “For patients with severe crowding caused by TSALD, are the occlusal and secondary outcomes of treatment with early first premolar extraction equivalent to those obtained with late treatment?”

They searched the databases of PubMed, Ovid, Scopus, Virtual Health Library and The Cochrane Library to identify relevant studies, irrespective of language, in the electronic databases for papers published between 1900 and April 2014. They were looking for studies that evaluated the association between mixed dentition serial extraction and permanent dentition premolar extraction and that also reported on primary and secondary outcomes. Any studies that evaluated the beginning stages of treatment but did not compare them with outcomes were excluded.

The search strategy resulted in 588 articles, six of which were designated for review. Of these six articles, four presented the primary outcome: correction of severe crowding. The irregularity index was improved for both groups, without statistically significant differences on completion of the treatment.

Therefore, to discover evidence of the best treatment time, the researchers made secondary outcomes the target of the study. Post-retention crowding relapse, duration of total and active treatment, external apical root resorption and soft tissue profile were examined.

Results showed that two of the four secondary outcomes – relapse and active treatment – were favorable to early intervention. Root resorption and soft tissue profile showed no statistically significant differences.

Among conclusions, authors said that despite limited evidence in the studies, early and late treatment presented similar primary outcomes for relief of crowding. Early treatment also showed less relapse and reduced treatment time with appliances. They called for controlled studies and randomized clinical trials to clarify the best treatment time for severe TSALD.

http://www.ncbi.nlm.nih.gov/pubmed/25208231

 
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CS Solutions
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http://go.carestreamdental.com/l/1164/2014-08-12/3gb433

 

Misleading information on elastics may be widespread

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The hazards of patient self-treatment for excessive interdental spacing were explored in an editorial published in the September 2014 issue of the American Journal of Orthodontics and Dentofacial Orthopedics.

The editorial noted that rubber bands are commonly used in orthodontics in very specific and prescribed ways. Although safe and effective procedures have long been described in the literature, so have risky practices and negative consequences.  The practice of using elastics placed solely around the teeth to close interdental spaces can provide tooth movement but result in significant problems for the patient.

Because tooth loss and subsequent repair requiring complex and expensive dental procedures are potential outcomes with unsupervised and unsecured tooth movement using only rubber bands, dentists typically consider such uncontrolled practice below the standard of care.

Evidently, comparable awareness hasn’t made the same inroads in consumer education on tooth movement and use of elastics, Dr. Rolf G. Behrents, editor-in-chief of AJODO reports.

Describing the term “gap bands” as newly minted, he said it is “now in common use around the world” with commercially available products online for the unknowing consumer. 

He added, “Judging by the available videos, it is also clear that the topic is of considerable interest to many minors and adults. The most common risk being described on the Internet appears to be the chance of latex allergy; mentions of the possibility of rubber band aspiration and tooth loss appear to be scarce.”

He advises that consumers would benefit from proper information about the benefits and risks of any self-treatment.

“The use of elastics in orthodontic tooth movement can be advantageous, but their use is also associated with disadvantages and risks. This should be known and appreciated by practitioners and consumers alike.” 

http://www.ajodo.org/article/S0889-5406(14)00626-X/abstract

 

Upper airway changes after sleep apnea surgery

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Increasing the size of the airway with maxillomandibular advancement (MMA) surgery has been shown to eliminate or improve obstructive sleep apnea (OSA). However, despite the important role MMA plays in correcting the problem, specific changes in the upper airway that influence surgical outcomes may not be well understood.

Scientists publishing in the September 2014 issue of the American Journal of Orthodontics and Dentofacial Orthopedics reported a dearth of evidence, including a lack of data defining surgical success, shortcomings in preoperative imaging and evaluations of the upper airway and no systematic reviews of cone-beam computed tomography (CBCT) analysis of the upper airway in OSA patients.

Seeking to help surgeons and orthodontists in treatment planning through better understanding of anatomical abnormalities and impactful transformations after surgery, the team studied the upper airway in patients with OSA both before and after MMA surgery.

To conduct their research, scientists evaluated preoperative and postoperative CBCT scans and polysomnograms of ten consecutive patients – eight men and two women of an average 46.4 years of age with high pre-operative apnea/hypopnea index (an index that measures the apnea and hyponea episodes per hour to better determine the severity of sleep apnea) – who had undergone MMA for moderate or severe OSA. They analyzed upper airway changes in the subjects by comparing volumetric, height, cross-sectional surface area, transverse, and anteroposterior diameter changes of presurgical and postsurgical scans.

Among major findings, scientists observed a 2.5-fold average increase in the total volume of the upper airway space. The greatest change in a cross-sectional area occurred in the transverse airway dimensions.

“MMA as shown in this study and by others is an effective treatment option with a high degree of success for patients with OSA who cannot tolerate CPAP [continuous positive airway pressure] therapy or wish to have a definitive correction of the condition,” the authors said among their conclusions. Within discussion, they noted that their study using CBCT accounted for airway shape and size only when the patient is awake and in an upright, sitting position. When the patient is asleep and prone, tissues surrounding the airway relax and develop more obstruction-decreasing the air volume. However, one can postulate that this tissue relaxation likely is true for both pre and post-operative patients with the degree of post-surgical change accounting for the reported normalization of the apnea/hypopnea index. The authors called for more research to allow precise planning based on expected airway changes with surgery.

 http://www.ncbi.nlm.nih.gov/pubmed/25172261

Capture high-resolution images with the CS 3500 intraoral scanner

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With CS Solutions for Orthodontists, users have the option to create digital impressions with the CS 3500 intraoral scanner for use with new CS Model software.

The CS 3500 intraoral scanner acquires true color, 2D and 3D images without the need for a heater, powder or trolley system. The scanner features high-angulation scanning of up to 45 degrees and to a depth from -2 to +13 millimeters. It also includes an autoclavable tip available in two sizes, a smaller tip for children or adults with small mouths and a larger tip for adults, to ensure users adhere to the best practices for infection control.     

With the scanner, practitioners can capture high-resolution images digitally rather than using the putty associated with traditional impressions—eliminating the need for using impression material, pouring molds or waiting for stone models to set.

Once digital impressions are created, CS Model software takes basic distance measurements—including overjet, overbite, pressure map, arch length, tooth size, crowding measurement and more—to further improve clinicians’ diagnostic capabilities. CS Model enables orthodontists to quickly create digital models; review and store them electronically; and produce orthodontic appliances through preferred labs.

Creating digital models is an environmentally friendly solution that ensures that patients’ models are not damaged, lost or mixed-up over time. Plus, CS Model gives practices access to all cases 24/7, without the need to access third-party storage via the Internet.

Digital models not only save time and money, but also serve as a powerful tool to engage patients in treatment planning and increase case acceptance.

 http://go.carestreamdental.com/l/1164/2014-08-12/3gb433

 
advertisement
The template calls for the image at 160 by 160 but adjustments can be made

CS Solutions
With CS Solutions for Orthodontics, doctors can eliminate the hassle and costs associated with stone models. Using the CS 3500 intraoral scanner, orthodontists can capture digital impressions without the use of powder. Next, CS Model software makes it easy to create accurate digital models for orthodontic applications, which can then be sent directly to the lab for appliance fabrication.

http://go.carestreamdental.com/l/1164/2014-08-12/3gb433

 

What is Specialty Scan?

This is one in a series of quarterly newsletters updating dentists on selected specialties in dentistry. Information presented is aggregated and summarized from previously published materials, each item attributed to its publication of origin. This issue of JADA Specialty Scan focuses on orthodontics, the fourth in the series on this topic for 2014. Other Specialty Scan issues are devoted to periodontics, endodontics, oral and maxillofacial radiology and prosthodontics. The ADA has engaged the specialty organizations in these areas as well as its own divisions of Science and Legal to assist with these newsletters. We welcome feedback on this and all Specialty Scan issues.

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