An evaluation of cone-beam computed tomography use in postgraduate orthodontic programs in the United States and Canada

The purpose of this study was to evaluate the use of cone-beam computed tomography (CBCT) in postgraduate orthodontic residency programs. An anonymous electronic survey was sent to the program director/chair of each of the sixty-nine United States and Canadian postgraduate orthodontic programs, with thirty-six (52.2 percent) of these programs responding. Overall, 83.3 percent of programs reported having access to a CBCT scanner, while 73.3 percent reported regular usage. The vast majority (81.8 percent) used CBCT mainly for specific diagnostic purposes, while 18.2 percent (n=4) used CBCT as a diagnostic tool for every patient. Orthodontic residents received both didactic and practical (hands-on) training or solely didactic training in 59.1 percent and 31.8 percent of programs, respectively. Operation of the CBCT scanner was the responsibility of radiology technicians (54.4 percent), both radiology technicians and orthodontic residents (31.8 percent), and orthodontic residents alone (13.6 percent). Interpretation of CBCT results was the responsibility of a radiologist in 59.1 percent of programs, while residents were responsible for reading and referring abnormal findings in 31.8 percent of programs. Overall, postgraduate orthodontic program CBCT accessibility, usage, training, and interpretation were consistent in Eastern and Western regions, and most CBCT use was for specific diagnostic purposes of impacted/supernumerary teeth, craniofacial anomalies, and temporomandibular joint (TMJ) disorders.

Temporary anchorage device utilization: comparison of usage in orthodontic programs and private practice

AIM

There is limited data on how temporary anchorage devices (TADs) are currently used in orthodontics. The aim of this study was to survey two groups of orthodontic providers-graduate orthodontic residencies and private practitioners-about their use.

METHODS

A 15-question survey was prepared and administered to all 61 accredited orthodontic residencies and an equal number of private orthodontic practitioners (all in the United States). A second survey was also included and provided to the residency programs.

RESULTS

The response rate was 63.9% for private practitioners and 70.4% for orthodontic residency programs. The majority of the residency programs (82.9%) and practitioners (69.2%) reported placing TADs in their practices. TADs were placed in 6.0% of the patients treated by private practitioner and in 5.3% of patients treated in residency programs. A combination of topical and local anesthesia was the anesthetic of choice for 59.0% of private practitioners and 65.0% of orthodontic residency programs. A large majority of the private practitioners (79.0%) and orthodontic residency programs (61.9%) reported that the TADs were loaded immediately. The most frequently cited use for TADs was anterior en masse retraction. In total, 27.9% of the residency programs used miniplates, compared to 17.9% of the practitioners.

CONCLUSION

Since 2005, a large number of US programs have incorporated TADs into their didactic/research curriculum and residency programs. Both mini-implants and miniplates may have a far-reaching impact on the clinical practice of orthodontics for decades to come. This survey detailed the trends and differences between practitioners and residencies in the TAD utilization experience and provided important information that is otherwise not available in the literature.

Attitudes of postgraduate orthodontic students in India towards patient-centered care

The aim of our study was to assess the attitudes of postgraduate orthodontic students in India towards patient-centered care. Two hundred and two students from eighteen dental schools across India completed the modified Patient-Practitioner Orientation Scale (PPOS), a self-administered eighteen-item questionnaire that evaluates the practice orientation of the students in terms of doctor versus patient-centeredness. The results revealed that the attitudes of the orthodontic postgraduate students in India were generally more doctor-centered (mean PPOS score of 3.38). As compared to their male counterparts, the female students were more considerate of the role of psychosocial factors in health and the importance of warm doctor-patient relationships (mean caring subscale score of 3.8 vs. 3.54, p<0.05). The third-year students were relatively more patient-centered than their first-year colleagues (mean PPOS score of 3.56 vs. 3.27, p<0.05) and were more willing to share power and information with their patients (mean sharing score of 3.24 vs. 2.92, p<0.01). In general, the students became more patient-centered as they progressed through their postgraduate course. The results of the study clearly imply the need for more active measures in order to develop a more patient-centered orthodontic health care system in India.

A review of pediatric dentistry program websites: what are applicants learning about our programs?

The purpose of this study was twofold: 1) to examine website content provided by U.S. and Canadian pediatric dentistry residency programs, and 2) to understand aspects of program websites that dental students report to be related to their interests. Sixty-eight program websites were reviewed by five interprofessional evaluators. A thirty-six-item evaluation form was organized into 1) program descriptive items listed on the American Academy of Pediatric Dentistry (AAPD) website (n=21); 2) additional program descriptive items not listed on the AAPD website but of interest (n=9); and 3) items related to website interface design (n=5). We also surveyed fifty-four dental students regarding their interest in various aspects of program descriptions. The results of this study suggest that pediatric dentistry residency programs in general tend to provide identical or less information than what is listed on the AAPD website. The majority of respondents (76 percent) reported that residency program websites would be their first source of information about advanced programs. The greatest gap between the available website information and students' interests exists in these areas: stipend and tuition information, state licensure, and program strengths. Pediatric dentistry residency programs underutilize websites as a marketing and recruitment tool and should incorporate more information in areas of students' priority interests.

A process for developing assessments and instruction in competency-based dental education

A process for the development of assessments and supporting instructional components in competency-based dental education is described. This process is illustrated using the example of an educational module in the management of malocclusion and skeletal problems at New York University College of Dentistry. The process begins with identifying the final outcome of the skill to be assessed and constructing an assessment that represents a relevant clinical situation. Such an assessment requires students to employ key enabling or foundational knowledge, specified subskills, and evaluative criteria. Once the components essential to mastering the assessment are identified, an instructional module that facilitates attainment of competence can be developed. This module is complemented by a companion piece that is content-specific and directs teachers and students to reach instructional targets. Assessments, supported by the components described in this process, increase the cognizance of the dental educator and provide mechanisms to evaluate student achievement and instructional effectiveness.

Comparative use of Invisalign by orthodontists and general practitioners

OBJECTIVE

To test the hypothesis that there is no difference in the use of Invisalign between orthodontists and general practitioners.

MATERIALS AND METHODS

A questionnaire was mailed to all Invisalign providers within a 35-mile radius of Stony Brook University. The answers were statistically analyzed. The level of significance was set at P < .05.

RESULTS

Orthodontists started more Invisalign cases (P < .0001). General practitioners started more Invisalign cases in the last 12 months (P = .0012). For both groups, the percentage of cases started in the last 12 months was inversely related to the number of years certified in Invisalign (P < .0001). Significant differences in opinion (P < .001) were noted between orthodontists and general practitioners regarding the level of experience necessary to treat a Class I malocclusion with a large diastema, and whether a Class II subdivision case should be treated with Invisalign.

CONCLUSION

The hypothesis is rejected. The use of Invisalign by orthodontists and general practitioners was compared, and significant differences were found.

The correlation between craniofacial morphology and sleep-disordered breathing in children in an undergraduate orthodontic clinic

PURPOSE

The aim of this study was to assess children in an orthodontic teaching clinic to determine the relationship between sleep-disordered breathing (SDB) symptoms and craniofacial morphology.

METHODS

All parents were asked to complete a SDB questionnaire at the commencement of orthodontic therapy. A cephalometric analysis included face heights, hyoid position, soft palate lengths, mandibular, vertical airway, overjet, and overbite. Study model measurements included dental width, depth, and palatal height. The subjects were divided into two groups according to their dentition stage: early or late mixed.

RESULTS

Data from 173 children (male 50.3%, mean age 10.1 ± 1.7 years) that completed the OSA-18 questionnaire and the cephalometric (CA) and model (MA) analyses were evaluated. The questionnaire suggested that only two children in the orthodontic pool had an increased chance of exhibiting SDB. However, loud snoring, mouth breathing, and difficulty awakening were reported in more than 20% of the children. Overall, a higher total score correlated with retroclined upper incisors (CA) and high palatal height (MA, p < 0.05). Although there was no significant score differences between the groups, a higher total score correlated with a long soft palate (CA, p < 0.05) in the early mixed dentition group and a high palatal height (MA) in the late mixed dentition group (p < 0.05).

CONCLUSION

Even though few patients were suspected as having SDB, symptoms were related to many cephalometric variables and study model measurements. Since the etiology of SDB is believed to involve multiple factors, such patients may exhibit some risk of developing SDB in the future.

Problem-based learning in postgraduate dental education: a qualitative evaluation of students' experience of an orthodontic problem-based postgraduate programme

INTRODUCTION

Problem based learning (PBL) has gained wide acceptance in undergraduate education, but less so in postgraduate education. Qualitative research methodologies can help us gain insight and understanding of the students' experience in undertaking such programmes.

AIM

To evaluate the experiences of postgraduate students undertaking a PBL based postgraduate programme.

METHODS

Focus groups and semi-structured interviews were used to investigate students' experiences. The qualitative data were coded, the codes were grouped into categories and a coding framework developed. From this a construct is proposed to give insight into students' experiences. The validity of this construct was examined by reviewing the literature.

RESULTS

Students entered the programme with high expectations, but soon found they had challenges to overcome. They came to realise that they were on a journey, rather than undertaking a sequence of separate individual learning events. PBL led to significant tensions both within the individuals and the group, caused by the conflict between appreciating PBL as a 'good thing' and yet finding that ;it just doesn't seem to work'. The fear of failure in a high stakes setting only exacerbated these tensions. The literature review revealed an inconsistent approach to the use of PBL and its evaluation in a postgraduate/continuing medical education setting. However it did provide evidence of similar findings in qualitative studies, supporting the construct developed.

CONCLUSION

We have proposed a construct to help in understanding the PBL experience for students undergoing a 'high stakes' orthodontic postgraduate programme with a core of PBL.

Future provision of orthodontic care for patients with craniofacial anomalies and cleft lip and palate

OBJECTIVE

To determine whether Canadian and United States (US) orthodontic programs provide training in treating patients with cleft lip and palate (CLP) and craniofacial anomalies (CFA) and whether residents will treat these patients in their future practices.

METHODS

An email with a personalized link to an anonymous, multi-item, online questionnaire was sent to all 54 Canadian and 335 of the approximately 700 US orthodontic residents. The two questions asked were: "Do you plan to include the treatment of CLP and CFA patients in your practice?" and "Does your program contain formal training in treating patients with CLP and CFA?"

RESULTS

A total of 44 Canadian and 136 US residents responded. In Canada, 30% plan to treat patients with CLP and CFA after graduation, 14% said no, 48% said maybe, and 9% were unsure. In the US, 53% said yes, 7% said no, 36% said maybe, and 4% were unsure. When asked if their program offers formal training in the treatment of these patients, 45% of Canadian residents said yes, 34% said no, and 20% were unsure, whereas 82% of US residents said yes, 12% said no, and 5% were unsure.

CONCLUSION

Most programs in the US and approximately half in Canada provide training in CLP and CFA, and more than half of US and almost one-third of Canadian residents plan to be involved in the care of patients with CLP and CFA, which is considerably less than those receiving training. Orthodontic programs need to increase the number of postgraduate students who are interested in providing care to CLP and CFA patients after becoming orthodontists.

Resident evaluation of orthodontic programs in the United States

The objective of this study was to investigate the satisfaction of orthodontic residents in the United States with their programs and determine the scope of their training. Program chairs/directors of all sixty-five U.S. orthodontic graduate programs were contacted for permission to email their residents. A total of 335 residents from thirty-seven programs were invited to complete an anonymous, online, fifty-seven-item survey in May 2007. Data were categorized, and basic statistics were performed. A total of 136 (40.60 percent) residents completed the survey. Overall, 75.74 percent were satisfied with their program. Residents said they feel they receive appropriate didactic teaching sessions and dedicated academic time (60.29 percent). Most residents (92.70 percent) indicated their program offers training in numerous philosophies, while 80.29 percent said they have sufficient clinically based training and 59.85 percent said they have sufficient research-based training. A total of 57.66 percent said they will not complete more than thirty cases from start to finish and on average treat two orthognathic surgery, thirteen extraction, twenty-four nonextraction, and nine adult patients. Most (92.70 percent) said their program contains care for disabled or underserved patients; most (92.70 percent) said they feel they will be adequately prepared to provide unsupervised orthodontic care after graduation; and 54.41 percent said they think other specialties have a positive view of orthodontics. Only 58.09 percent indicated they have a formal interdisciplinary program for treating patients. We conclude that U.S. orthodontic residents are satisfied with their programs. They receive training in a variety of approaches; however, inadequacies in exposure to interdisciplinary teaching and a limitation of the number of cases started and completed were identified. These observations may be a result of program length due to the preponderance of twenty-four- to thirty-month programs.