AIM:The study aimed to compare the fit of thermoformed aligners fabricated on the original dental model over the corresponding dental models created using rapid-prototyping, in horizontal or vertical orientations using scanning electron microscopy (SEM). METHODS:This study involved scanning 10 dental models using a Maestro 3D Desktop Scanner. The 10 processed STL files were then additively manufactured into 20 models using a PolyJet printer, 10 models printed in horizontal or vertical orientations, respectively. Two thermoformed aligners using 0.75 mm Duron blanks were fabricated over each original dental model with a Biostar machine and were adapted over the corresponding additively manufactured models. Models manufactured in two different orientations along with aligners were sectioned on the upper and lower-central incisors, first premolars and first molars and were prepared for SEM evaluation. The difference in data between the two groups was determined using an unpaired t-test. RESULTS:The fit of aligners on additively manufactured dental models in vertical or horizontal orientations was generally comparable. Across all regions evaluated, the mean measured discrepancies ranged below 196.2 ± 44.32 µm, which falls within ranges previously reported in the literature as clinically acceptable for thermoformed aligners (117.76 ± 23.58-196.2 ± 44.32 µm). CONCLUSION:SEM evaluation revealed that thermoformed aligners fabricated on the original dental models demonstrated a comparable fit on rapid-prototyped dental models, with no significant differences observed between models fabricated in horizontal or vertical three-dimensional printing orientations.
BACKGROUND:Patient satisfaction is an important indicator of healthcare quality and a determinant of treatment success. AIMS:To assess parents'/carers' satisfaction with their children's/adolescents' orthodontic treatment and to investigate associations among study variables using a validated instrument. METHODS:A cross-sectional survey study was conducted with parents/carers of 68 children/adolescents aged 6-17 years. Satisfaction was assessed using the Questionnaire of Satisfaction with Orthodontic Treatment, comprising 25 items distributed across three subscales: treatment process, psychosocial effect of treatment and treatment outcome. Sociodemographic and clinical data were also collected. Descriptive analyses and Poisson regression models were performed, with results expressed as odds ratio (OR) and 95% confidence interval (CI). RESULTS:Of the 68 parents/carers, 48 (70.6%) were male. Among the children/adolescents, 34 (50%) were male (mean age 12.84 years). Parents/carers from households with four or more individuals had significantly lower satisfaction scores on the treatment process subscale than those from households with three or fewer individuals (OR = 0.93; 95% CI = 0.83-0.98; P = 0.016). Parents/carers of children/adolescents who had undergone corrective treatment had significantly higher scores on the psychosocial effect subscale (OR = 1.10; 95% CI = 1.01-1.21; P = 0.023), treatment outcome subscale (OR = 1.07; 95% CI = 1.01-1.14; P = 0.016) and total score (OR = 1.06; 95% CI = 1.01-1.13; P = 0.032) than those whose children/adolescents had received interceptive/corrective treatment. Parents/carers of children/adolescents with more severe malocclusion reported significantly higher satisfaction scores than those with less severe malocclusion (OR = 1.02; 95% CI = 1.01-1.03; P = 0.010). CONCLUSIONS:Family size, type of orthodontic treatment and malocclusion severity were associated with parents'/carers' satisfaction with their children's/adolescents' orthodontic treatment.
OBJECTIVE:To explore the relationship between malocclusion, orthodontic treatment and peer relationships in adolescents. DESIGN:A cross-sectional qualitative study. SETTING:Three secondary schools in the South-East of the U.K. PARTICIPANTS:A total of 14 schoolchildren aged 14-16 years (mean age = 15.7 years; age range = 14.4-16.5 years). METHODS:In-depth one-to-one semi-structured interviews carried out online. All interviews were transcribed verbatim and analysed thematically according to Braun and Clarke's model of thematic analysis. RESULTS:The central finding of this research was that adolescents are self-conscious of their dental appearance, it impacts on social interactions, and peers and friends are both a source of pressure and support regarding dental appearance and treatment. Two main themes were identified: (1) malocclusion and peer relationships; and (2) social expectations and experience of orthodontic treatment. Participants reported being self-consciousness of their teeth before treatment, and this increased with age. They feared being judged based on their dental appearance, undertaking behaviour to hide their teeth in social situations, in photographs or online. All participants reported either being teased personally about their teeth or witnessing this happening to someone else although they mostly did not see this as bullying. This had a negative impact on self-confidence. No one reported being teased after starting orthodontic treatment. Orthodontic treatment was seen as desirable and normal within this age group, with an expectation it would improve self-confidence, particularly in social settings. Friends and peers were a source of support during treatment. CONCLUSION:Young people are self-conscious of their dental appearance, which impacts their peer relationships and can make them a target for teasing and bullying. Orthodontic treatment is considered normal, with peers and friends providing support.
OBJECTIVES:To assess the prevalence of e-cigarette use among orthodontic patients in a UK hospital setting, while investigating patterns of use and evaluating patients' knowledge of the oral health effects of e-cigarettes, along with how it may impact orthodontic treatment outcomes. METHODS:A cross-sectional survey was administered to patients aged 11 years and above attending routine appointments at the Orthodontic Department of St George's University Hospitals NHS Foundation Trust over 3 months. The 34-item survey captured demographics, e-cigarette use and device type, initiation age, cessation attempts, knowledge of oral health effects, perceived treatment impact and patient-clinician communication. Descriptive statistics were used for data analysis. RESULTS:A total of 140 participants completed the survey. A high prevalence of e-cigarette use was observed, with 25% of participants having tried them and 14.3% of all participants being regular users. The average age of initiation was 16 years, and 68% of users had no history of tobacco smoking. Reasons for use were primarily 'curiosity' (38%) and 'social reasons' (32%). A significant knowledge gap regarding oral health risks was identified, with only 11% of participants rating themselves as 'very' or 'extremely' knowledgeable. Despite this, 82% of participants believed e-cigarette use could affect their braces and 59% expressed some concern. A notable communication gap was found, as 92% of all participants had never spoken to their orthodontist about e-cigarette use. However, when advice was given, three out of four users reported a reduction or cessation of their habit. CONCLUSION:The prevalence of e-cigarette use in this cohort of orthodontic patients exceeds national averages and is largely driven by social factors. These patients have limited knowledge of the oral health risks and report a lack of clinical discussion, highlighting the need for routine screening, targeted education and cessation support from orthodontists.
OBJECTIVE:To explore experiences affecting patients' compliance with removable retention appliances, and to investigate strategies for improving adherence to wear recommendations from the profession. DESIGN:A qualitative study designed alongside a randomised controlled trial regarding post-treatment stability and patients' perceptions. SETTING:Orthodontic Clinic, Public Dental Health Service, Region Gävleborg, Gävle, Sweden. PARTICIPANTS:A total of 15 purposively selected participants (age range = 25-32 years) with a recommendation of long-term retainer wear. METHODS:In-depth interviews were performed, using a pre-tested topic guide, and analysed according to the qualitative method of Grounded Theory. RESULTS:Compliance failures were preceded by one or more triggers that emerged after a couple of weeks or after several years of retention. A core category was identified and labelled 'Pragmatic actions for improved adherence', which summarises the decisions to either discontinue or continue to follow current retention protocol as being based on pragmatic patient-centred considerations. Data analysis revealed three interacting categories for improving compliance from both the patient and the clinician perspectives: Individual factors, Support, Self-motivation and Routines. CONCLUSIONS:To be successful, strategies to enhance compliance with removable retainers must originate from the individual patient and their life situation. Long-term support from both family and professionals, as well as good routines, are considered crucial for this process.
OBJECTIVE:To evaluate bovine enamel surfaces after removal of clear aligner composite attachments using different methods, considering temperature, noise and vibration generated by rotating instruments. The null hypothesis stated that there would be no differences among methods. MATERIAL AND METHODS:A total of 56 specimens were randomly assigned to seven groups according to the removal technique: pencil-tip diamond bur at high-speed (CG); latch-lock multiblade bur at low-speed (LG); friction-grip multiblade bur at high-speed without irrigation (HG); friction-grip multiblade bur at high-speed with irrigation (HIG); aluminium-oxide tips at low-speed (AOG); Sof-Lex™ Pop-On discs at low-speed (SLG), applied from coarse to fine; and Enhance silicone tips at low-speed (EG). Surface roughness was measured using a 3D optical profilometer (Nanovea PS50) and microhardness with a Knoop microhardness tester (Buehler MICROMET 5104). During composite removal, temperature was monitored with a digital infrared thermometer (Lasergrip GM 400), noise with a decibel metre (DL-1100), and vibration with a vibration metre (WT63A). RESULTS:AOG produced the highest mean vibration (2.6 ± 0.4 mm/s; P < 0.001), LG generated the highest mean temperature (31 ± 1.2°C; P < 0.001) and CG produced the highest mean noise levels (90.3 ± 2.1 dB; P < 0.001). SLG showed the smallest mean change in roughness (ΔRa: 0.46 ± 0.57). CONCLUSION:All removal methods increased enamel roughness and reduced microhardness, with significant differences in temperature, noise and vibration. AOG and SLG caused less enamel damage and better surface preservation, indicating they may represent safer clinical options. The null hypothesis was therefore rejected.
OBJECTIVES:To explore the prevalence of discrepancies between estimated and actual orthodontic treatment duration and identify predictors of treatment delays. MATERIAL AND METHODS:A total of 96 patients (62.5% female; age = 15.6 ± 6.8 years) who completed an orthodontic treatment with pre-adjusted edgewise fixed appliances between 2015 and 2023 were retrospectively included. Differences between actual and estimated treatment duration >3 months were classified as discrepancies and categorised as "overestimation" or "underestimation." Such discrepancies were compared on demographics, COVID period, and orthodontic parameters using Student's t-tests and chi-square tests, as appropriate. Predictors of underestimated treatment duration were assessed with logistic regression analysis. RESULTS:Actual treatment duration significantly differed from the estimated duration (26.5 ± 9.6 vs. 21.6 ± 3.6 months; P <0.001), with 65.6% cases exhibiting treatment discrepancy (P = 0.003) and 61.5% of them being underestimated (P = 0.032). Cases with underestimated durations more commonly displayed posterior crossbite (30.9% vs. 5.4%; P = 0.004), larger SNA angle (83.7 ± 3.7 vs. 78.8 ± 3.8 degrees; P = 0.005), bracket debonding (53.4% vs. 31.4%; P = 0.039; odds ratio [OR] = 2.51, 95% confidence interval [CI] = 1.04-6.04), and were most likely conducted during COVID period (33.9% vs. 10.8%; P = 0.011; OR = 4.23, 95% CI = 1.31-13.62) compared to overestimated ones. Posterior crossbite (P = 0.006) and COVID period (P = 0.007) were significant predictors of treatment underestimation. CONCLUSIONS:Approximately two-thirds of orthodontic treatments showed discrepancies between estimated and actual duration, with 61.5% being underestimated especially in presence of posterior crossbite and during COVID period.
OBJECTIVE:To investigate access to, frequency of use, justification, challenges and training regarding cone-beam computed tomography (CBCT) imaging in orthodontics in the UK. DESIGN:Cross-sectional questionnaire study. SETTING:Web-based. METHODS:An online questionnaire was developed after a review of the literature and discussion with practising orthodontists to identify key themes of importance. It was piloted before use and then distributed via the British Orthodontic Society (BOS). All responses were anonymous. RESULTS:A total of 82 complete responses were received (~7% response rate). Access to CBCT facilities was primarily through NHS secondary care (68%). Usage was mainly for assessment of impacted teeth, and 80% of respondents who use CBCT reported increased CBCT imaging referrals over the past 5 years. Barriers included geographic distance and cost. Almost 60% of respondents had formal CBCT training, but over one-third lacked easy access to dental/maxillofacial radiology reporting. CONCLUSIONS:Access to CBCT for orthodontic patients in the UK was mainly through NHS secondary care. Most respondents reported using CBCT for fewer than 10% of patients, most commonly for assessment of unerupted or impacted teeth. The majority of those who used CBCT reported an increase in CBCT referrals over the past 5 years. Reported challenges included cost, travelling distance to CBCT facilities, and limited access to dental and maxillofacial radiology reporting. Although most respondents had undertaken formal CBCT training, over one-third reported difficulty accessing specialist radiology support.
