Rapid and substantial advances in imaging methods and technology have not always been expediently or adequately communicated to the practicing orthodontist. In this review we highlight contemporary imaging techniques and innovations in imaging that, in the future, are likely to greatly improve the depiction of craniofacial structures for use in diagnosis and treatment planning. In order to provide an appropriate background for this topic, we first discuss the evolution of craniofacial imaging in orthodontics and review the limitations of current methods, including the two-dimensional representation of three-dimensional anatomy, depiction as a patchwork of site-specific images, associated geometric errors, and images that have a limited point of view and are static in space and time. Three-dimensional computed tomography can be considered a partial solution to these limitations, but imaging costs, radiation exposure, and lack of soft tissue representation may make it unacceptable for routine orthodontics. A more complete solution might be achieved through digital processing of contemporary imaging technologies that would extend their capabilities, overcome many of their limitations, and result in an increase in the amount of relevant information obtained. Digital processes are currently being developed that create accurate multidimensional models that integrate form and function. These models will be interactive, linked to knowledge databases, and will provide the clinician with answers to pertinent questions. These advances in imaging are likely to enhance the accuracy and reliability of orthodontic diagnosis and treatment planning, and will be of importance in both clinical practice and research.
The study of growth and development of the facial profile is of interest to clinicians and researchers in the fields of pediatric dentistry, orthodontics, and craniofacial surgery, enabling diagnosis, planning, and evaluation of treatment. Until recently, craniofacial studies addressed facial growth, facial asymmetry, and gender differences by examining changes in size. However, size changes alone do not represent fully the complicated process of craniofacial growth which also involves changes in shape. The shape of the facial profile can now be quantified with Fourier analysis, contributing to a better understanding of growth. A combination of recently developed methods, such as 3-dimensional facial morphometry and Fourier analysis, should allow a more comprehensive knowledge of growth and development of the craniofacial structures, including the facial profile. This article examines various methods for assessing facial growth and development currently available with particular reference to the facial profile, and addresses the value of Fourier analysis in assessing shape changes.
Orthodontic treatment of adult patients with complex dental problems is done in interdisciplinary teams where different specialists of dental medicine have to manage a vast quantity of data. In such complicated cases good diagnostic tools and easy communication are essential Computer science has an increasing impact in almost every aspect of the orthodontic practice, research and education. Within the past decade, technology termed "cone beam computed tomography" (CBCT) has evolved that allows 3-D visualization of the oral and maxillofacial complex from any plane. With the development of Cone Beam Computed Tomography, there has been a drastic reduction in radiation exposure to the patient, which allows its use for safely obtaining three dimensional images of the craniofacial structures. This should allow the clinician to visualize the hard and soft tissues of the craniofacial region from multiple perspectives, which could have far-reaching implications for treatment planning in orthodontics and orthognathic surgery. This paper shall discuss in detail the principles of the cone beam computed tomography and its applications in the field of orthodontics.
Biological research related to orthodontics naturally leads to two general areas. One is the investigation of craniofacial growth and development in normal and abnormal circumstances, attempting to understand the etiological basis for the development of malocclusion or dentofacial deformity. The other concerns developing an understanding of the basic mechanisms involved in tooth movement during orthodontic therapy. This paper reviews ongoing research in both areas.
The relationship between orthodontics and temporomandibular disorders (TMDs) constitutes a subject of paramount significance in dental and craniofacial health. This abstract embarks upon an in-depth examination of the intricate connection between orthodontic practices and TMD, primarily focusing on evaluating the impact of orthodontic treatment modalities on the health and functionality of the temporomandibular joint (TMJ). This exploration elucidates the multifaceted interplay between orthodontic interventions and TMD by traversing a landscape of scholarly research and empirical investigations. The review draws from a broad spectrum of studies to analyze the potential influence of orthodontic treatments, which encompass occlusal adjustments and alterations in jaw positioning, on the development and management of TMD symptoms. The inquiry delves into the diverse range of TMD conditions, considering the implications of orthodontic techniques on occlusal stability, condylar alignment, and overall TMJ function. Through a comprehensive synthesis of the available body of knowledge, this abstract aspires to equip dental practitioners, orthodontists, and researchers with a nuanced understanding of the complex dynamics that govern the relationship between orthodontics and TMD. This knowledge, in turn, offers a foundation for informed clinical decision-making and the formulation of effective treatment strategies for patients presenting with TMD symptoms. By shedding light on the intricate interactions between orthodontic procedures and TMJ health, this abstract contributes to the advancement of clinical practices, promoting improved patient outcomes and well-being in the context of both orthodontics and TMDs.
Background/Objectives: Although secular trends have been well documented in the craniofacial region, there is no evidence to suggest that these temporal changes exist in samples used for orthodontic research. The aim of this study is to determine the effect of secular trends on craniofacial growth in a series of longitudinal birth cohorts that are frequently used in orthodontic research. Materials/Methods: Cephalometric data from serial lateral headfilms of 138 adolescents (total of 1252 cephalograms) were collected from the Craniofacial Growth Legacy Collection, which includes nine historical growth studies that were mostly conducted throughout the past century. Mixed-effects linear models were used to test the effect of 'year of birth (yob)', 'age', and their interaction on six sagittal (SNA, SNB, ANB, S-N, Co-A, Co-Po) and two vertical (N-Me, ANS-Me) cephalometric measurements. Results: Five of the eight cephalometric variables showed a significant (P 0.017) 'yob' effect, with four of these indicating an increase over time (SNA, ANB, S-N, Co-A) and one indicating a decrease (SNB). Highly significant (P < 0.001) interactions between 'age' and 'yob' were found for the measurements SNA, ANB, Co-A, and S-N. Limitations: Some of the limitations of the present study include the use of a small, non-random sample of the original large-scale growth studies. Conclusions/Implications: Secular trends were found in the craniofacial growth records of the 138 participants derived from the longitudinal growth studies. These secular trends are likely to have important clinical implications for the findings of controlled clinical trials in orthodontics. More research is needed to establish the presence of secular trends in other historical collections.
Craniofacial modification by orthodontic techniques is increasingly incorporated into the multidisciplinary management of sleep-disordered breathing in children and adolescents. With increasing application of orthodontics to this clinical population it is important for healthcare providers, families, and patients to understand the wide range of available treatments. Orthodontists can guide craniofacial growth depending on age; therefore, it is important to work with other providers for a team-based approach to sleep-disordered breathing. From infancy to adulthood the dentition and craniofacial complex change with growth patterns that can be intercepted and targeted at critical time points. This article proposes a clinical guideline for application of multidisciplinary care with emphasis on dentofacial interventions that target variable growth patterns. We also highlight how these guidelines serve as a roadmap for the key questions that will influence future research directions. Ultimately the appropriate application of these orthodontic techniques will not only provide an important therapeutic option for children and adolescents with symptomatic sleep-disordered breathing but may help also mitigate or prevent its onset.
It is a great honor to conduct an interview with Professor Mark G. Hans, after following his outstanding work ahead of the Bolton-Brush Growth Study Center and the Department of Orthodontics at the prestigious Case Western Reserve School of Dental Medicine (CWRU) in Cleveland, Ohio. Born in Berea, Ohio, Professor Mark Hans attended Yale University in New Haven, CT, and earned his Bachelor of Science Degree in Chemistry. Upon graduation, Dr. Hans received his DDS and Masters Degree of Science in Dentistry with specialty certification in Orthodontics at Case Western Reserve University. During his education, Dr. Hans’ Master’s Thesis won the Harry Sicher Award for Best Research by an Orthodontic Student and being granted a Presidential Teaching Fellowship. As one of the youngest doctors ever certified by the American Board of Orthodontics, Dr. Hans continues to maintain his board certification. He has worked through academics on a variety of research interests, that includes the demographics of orthodontic practice, digital radiographic data, dental and craniofacial genetics, as obstructive sleep apnea syndrome, with selected publications in these fields. One of his noteworthy contributions to the orthodontic literature came along with Dr. Donald Enlow on the pages of “Essentials of Facial Growth”, being reference on the study of craniofacial growth and development. Dr. Mark Hans’s academic career is linked to CWRU, recognized as the renowned birthplace of research on craniofacial growth and development, where the classic Bolton-Brush Growth Study was historically set. Today, Dr. Hans is the Director of The Bolton-Brush Growth Study Center, performing, with great skill and dedication, the handling of the larger longitudinal sample of bone growth study. He is Associate Dean for Graduate Studies, Professor and Chairman of the Department of Orthodontics, working in clinical and theoretical activities with students of the Undergraduate Course from the School of Dental Medicine and residents in the Department of Orthodontics at CWRU. Part of his clinical practice at the university is devoted to the treatment of craniofacial anomalies and to special needs patients. Prof. Mark Hans has been wisely conducting the Joint Cephalometric Experts Group (JCEG) since 2008, held at the School of Dental Medicine (CWRU). He coordinates a team composed of American, Asian, Brazilian and European researchers and clinicians, working on the transition from 2D cephalometrics to 3D cone beam imaging as well as 3D models for diagnosis, treatment planning and assessment of orthodontic outcomes. Dr. Hans travels to different countries to give lectures on his fields of interest. Besides, he still maintains a clinical orthodontic practice at his private office. In every respect, Dr. Hans coordinates all activities with particular skill and performance. Married to Susan, they have two sons Thomas and Jack, and one daughter Sarah, and he enjoys playing jazz guitar for family and friends.
Biocreative Orthodontic Strategy (BOS) is designed to establish a physiologically stable occlusion in harmony with masticatory and TMJ function and healthy supporting tissues with strategic use of temporary skeletal anchorage devices (TSADs). This narrative review surveys current research that demonstrates how BOS with TSADs uses a target approach to overcome the limitations experienced with conventional orthodontic treatment. A narrative review article including research on TSADs orthodontics in the permanent dentition. This review is a brief survey of five BOS principles for contemporary TSAD orthodontics: elegant selection of TSADs, bracket prescription to enhance TSAD orthodontics, antero-posterior dimension control, transverse dimension control and airway control issues. Severe malocclusion and craniofacial dysmorphology can be treated with Biocreative Orthodontic Strategy with a minimum number of TSADs. In order to achieve successful treatment outcome using TSADs, it is critical to understand the key diagnosis and treatment principles of BOS and how to develop a target approach for the tooth and bone movement.
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Since its introduction into dentistry in 1998, CBCT has become increasingly utilized for orthodontic diagnosis, treatment planning and research. The utilization of CBCT for these purposes has been facilitated by the relative advantages of three-dimensional (3D) over two-dimensional radiography. Despite many suggested indications of CBCT, scientific evidence that its utilization improves diagnosis and treatment plans or outcomes has only recently begun to emerge for some of these applications. This article provides a comprehensive and current review of key studies on the applications of CBCT in orthodontic therapy and for research to decipher treatment outcomes and 3D craniofacial anatomy. The current diagnostic and treatment planning indications for CBCT include impacted teeth, cleft lip and palate and skeletal discrepancies requiring surgical intervention. The use of CBCT in these and other situations such as root resorption, supernumerary teeth, temporomandibular joint (TMJ) pathology, asymmetries and alveolar boundary conditions should be justified on the basis of the merits relative to risks of imaging. CBCT has also been used to assess 3D craniofacial anatomy in health and disease and of treatment outcomes including that of root morphology and angulation; alveolar boundary conditions; maxillary transverse dimensions and maxillary expansion; airway morphology, vertical malocclusion and obstructive sleep apnoea; TMJ morphology and pathology contributing to malocclusion; and temporary anchorage devices. Finally, this article utilizes findings of these studies and current voids in knowledge to provide ideas for future research that could be beneficial for further optimizing the use of CBCT in research and the clinical practice of orthodontics.
Objective: To investigate in 10 orthodontic journals how many randomized controlled trials (RCTs) considered the Hawthorne effect, and if considered, to determine whether it was related to the patients or the therapists involved in the trial and, finally, to discuss the Hawthorne effect in an educational way. Materials and methods: A search was performed on the Medline database, via PubMed, for publication type 'randomized controlled trial' published for each journal between 1 August 2007 and 31 July 2017. The American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, Australian Orthodontic Journal, Dental Press Journal of Orthodontics, European Journal of Orthodontics, Journal of Orthodontics, Journal of Orofacial Orthopedics, Korean Journal of Orthodontics, Orthodontics and Craniofacial Research and Progress in Orthodontics were assessed. Two independent reviewers extracted the data and identified whether the Hawthorne effect was considered or discussed in the articles and whether the Hawthorne effect was related to the behaviour of the patients, the therapists, or both. Results: The initial search generated 502 possible trials. After applying the inclusion and exclusion criteria, 290 RCTs were included and assessed. The Hawthorne effect was considered or discussed in 10 of 290 RCTs (3.4%), and all were related to the patients' and none to the therapists' behaviour. Conclusions: The Hawthorne effect reported in orthodontic RCTs was suboptimal. The researchers' lack of knowledge about this phenomenon is evident, despite evidence that the Hawthorne effect may cause over-optimistic results or false-positive bias.
Clinical applications of 3D image registration and superimposition have contributed to better understanding growth changes and clinical outcomes. The use of 3D dental and craniofacial imaging in dentistry requires validate image analysis methods for improved diagnosis, treatment planning, navigation and assessment of treatment response. Volumetric 3D images, such as cone-beam computed tomography, can now be superimposed by voxels, surfaces or landmarks. Regardless of the image modality or the software tools, the concepts of regions or points of reference affect all quantitative of qualitative assessments. This study reviews current state of the art in 3D image analysis including 3D superimpositions relative to the cranial base and different regional superimpositions, the development of open source and commercial tools for 3D analysis, how this technology has increased clinical research collaborations from centres all around the globe, some insight on how to incorporate artificial intelligence for big data analysis and progress towards personalized orthodontics.
This review brings together for the first time the existing quantitative and qualitative research evidence about the experiences of parents caring for a child with a cleft. It summarizes salient themes on the emotional, social and service-related experiences of parents and critiques the literature to date, comparing it with wider, selected literature from the field of children's long-term conditions, including disability. The review suggests that there are similarities and differences between the literatures, in terms of research focus and approach. Similarities are found across children's conditions in the perspectives of parents on emotional, social and service-related aspects, although much of the cleft literature is focused on the early stages of children's lives. However, the quality of cleft research to date about parents' experiences has also been variable, with a narrow emphasis on cross-sectional, deficit-orientated psychological approaches focused mainly on mothers. Despite a substantial literature, little qualitative research has examined parents' perspectives in-depth, particularly about their child's treatment journey. This contrasts with the wider children's literature, which has traditionally drawn not only on psychological approaches but also on the broader perspectives of sociology, social policy, nursing and health services research, using both qualitative and quantitative methods, often in integrated ways. Such approaches have been able to highlight a greater range of experiences from both mothers and fathers, about caring for a child with a long-term condition and views about treatment. The review identifies a lack of comparable research in the cleft field to examine parents' experiences and needs at different stages of their children's lives. Above all, research is needed to investigate how both mothers and fathers might experience the long-term and complex treatment journey as children become older and to elicit their views about decision making for cleft treatments, particularly elective surgeries.
Patient pain is a common problem faced by dentists and oral and maxillofacial surgeons. Craniofacial pain may be caused not only by inflammation in the teeth, but also various oral, facial, and nerve-related diseases, as well as tumors. Non-steroidal anti-inflammatory drugs (NSAIDs) constitute the basis of the analgesic ladder. According to the World Health Organisation (WHO), NSAIDs are the first-line drugs in relieving pain and inflammation of oral conditions. NSAIDs have been used in almost every field of dentistry. These drugs are applied in conservative dentistry and endodontics, dental surgery, orthodontics, periodontology, and oral mucosal diseases, as well as head and neck oncology. Some of the NSAIDs exhibit additional therapeutic effects, such as inhibition of nuclear factor kappa B (NF-kappaB) and inducible nitric oxide synthase (iNOS), and reduction of oxidative stress or leukocyte passage to the site of inflammation, which further reduces inflammation in tissues. The topical use of NSAIDs in dentistry is worthy of attention and further research as it will significantly reduce the adverse effects of systemic administration. This article aims to review the preclinical and clinical studies that have supported the role of NSAIDs in dentistry.
Objective: To systematically evaluate in five orthodontic journals how many randomized controlled trials (RCTs) use intention to treat (ITT) analysis and to assess the methodological quality of the ITT analysis, and finally, to demonstrate in an academic way how outcomes can be affected when not implementing the ITT analysis. Material and methods: A search of the database, Medline, was performed via PubMed for publication type 'randomized controlled trial' published for each journal between 1 January 2013 and 30 April 2017. The five orthodontic journals assessed were the American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontics, European Journal of Orthodontics, Journal of Orthodontics, and Orthodontics and Craniofacial Research. Two independent reviewers assessed each RCT to determine whether the trial reported an ITT or not or if a per-protocol analysis was accomplished. Results: The initial search generated 137 possible trials. After applying the inclusion and exclusion criteria, 90 RCTs were included and assessed. Seventeen out of 90 RCTs (18.9%) either reported an ITT analysis in the text and/or supported the ITT by flow diagrams or tables. However, six RCTs applied and reported the ITT analysis correctly, while the majority performed a per-protocol analysis instead. Conclusions: Nearly all the trials that applied the ITT analysis incorrectly analysed the results using a per-protocol analysis, and thus, overestimating the results and/or having a reduced sample size which then could produce a diminished statistical power.
The aims of this study were to assess and compare the methodological quality of Cochrane and non-Cochrane systematic reviews (SRs) published in leading orthodontic journals and the Cochrane Database of Systematic Reviews (CDSR) using AMSTAR and to compare the prevalence of meta-analysis in both review types. A literature search was undertaken to identify SRs that consisted of hand-searching five major orthodontic journals [American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, European Journal of Orthodontics, Journal of Orthodontics and Orthodontics and Craniofacial Research (February 2002 to July 2011)] and the Cochrane Database of Systematic Reviews from January 2000 to July 2011. Methodological quality of the included reviews was gauged using the AMSTAR tool involving 11 key methodological criteria with a score of 0 or 1 given for each criterion. A cumulative grade was given for the paper overall (0-11); an overall score of 4 or less represented poor methodological quality, 5-8 was considered fair and 9 or greater was deemed to be good. In total, 109 SRs were identified in the five major journals and on the CDSR. Of these, 26 (23.9%) were in the CDSR. The mean overall AMSTAR score was 6.2 with 21.1% of reviews satisfying 9 or more of the 11 criteria; a similar prevalence of poor reviews (22%) was also noted. Multiple linear regression indicated that reviews published in the CDSR (P < 0.01); and involving meta-analysis (β = 0.50, 95% confidence interval 0.72, 2.07, P < 0.001) showed greater concordance with AMSTAR.
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