[Orthodontic treatment need: the IOTN, or Index of Orthodontic Treatment Need (part 2)]

[Discontinuation of Orthodontic Treatment: what are the early predictive factors?]

INTRODUCTION

Discontinuation of orthodontic treatment has iatrogenic, psychological, ergonomic and financial consequences. The objective of this study was to investigate early risk factors (prior to installation) of discontinuation of orthodontic treatment.

MATERIALS AND METHODS

We performed a case-control study between a group of patients who dropped their orthodontic treatment ("A") and a randomly selected group of patients who had completed their orthodontic treatment ("NA"). The two groups were compared, with descriptive, uni and multivariate analyzes. The risk factors assessed were age, gender, socioeconomic status, type of treatment, dysmorphism, malocclusion, need for treatment, compliance.

RESULTS

In the dropout group 55 patients were included ("A") and 100 in the non-abandoned ("NA") group randomly selected. The subject at risk of abandonment was a girl of less than 11 years of age with a low socio-economic level with antero-posterior and vertical skeletal dysmorphisms, a molar class II, a teeth crowding, a small aesthetic prejudice or, on the contrary, very important, complex treatment (with extractions or with surgery) and having delays or missed appointments before the installation of the orthodontic appliance.

CONCLUSION

Patients' motivation needs to be strengthened for both extremes: treatments that appear simple and conversely for complex cases requiring strong cooperation.

[Do scoliotic patients need increased orthodontic treatment? A comparative study on 104 cases]

INTRODUCTION

The diagnosis of scoliosis during orthodontic treatment is often attributed to orthodontic treatment, which may be a simple confounding factor. Do scoliotic patients require increased orthodontic treatment? Is the extent of their need for orthodontic treatment correlated with the severity of their scoliosis?

MATERIAL AND METHOD

The authors conducted a comparative multicenter epidemiological study between a group of patients with a proven diagnosis of scoliosis objectified by the Cobb angle and a control group recruited from the general population. The endpoint was the Index Of Orthodontic Treatment Need (IOTN). The calculation of the number of subjects was made a priori. A statistical significance threshold of 5% was used for the statistical analysis.

RESULTS

In this study, 104 patients were included: 36 patients (10 boys, 26 girls) with an average age of 12.1 years (+/-2.3 years) in the scoliosis group (mean Cobb angle = 21°) versus 69 patients (20 boys, 49 girls) with an average age of 12 years (+/-2.7 years) in the control group. Patients with scoliosis have a significantly higher need for orthodontic treatment than the general population. The study did not correlate the severity of scoliosis with the increased need for orthodontic treatment.

DISCUSSION

Thus, the diagnosis of scoliosis during orthodontic treatment should not systematically result in the removal of the orthodontic appliance over-hastily held responsible for the scoliotic condition.

[Translation and cultural adaptation of a french version of the psychosocial impact of dental aesthetics questionnaire: PIDAQ]

The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is a tool developed and validated to specifically assess subject's quality of life related to orthodontic anomalies. The aims of the present study were to translate and culturally adapt the PIDAQ's native English version into French, and to test the psychometric characteristics of the version thereby obtained. Toward these ends, the PIDAQ's original English version was translated into French and back-translated into English following the prescribed guidelines. Each of the versions obtained from the translation process was further subjected to a committee review. The final French version which is named QIPEO underwent an analysis of psychometric properties on a sample of 42 subjects (33 females and 9 males, aged 24.60 ± 8.66 years). Internal consistency was good with Cronbach ff coefficients ranging from 0.67 for "aesthetic concerns" to 0.87 for "social impact". The reproducibility of the responses given by 14 subjects after 15 days interval was correct with intraclass coefficients ranging from 0.72 for "social impact" to 0.90 for "aesthetic concerns". Furthermore, the different subscales of the French version of the PIDAQ showed excellent correlation with the perception of aesthetics and fairly good correlation with self-perception of orthodontic treatment need. Definite need for orthodontic treatment, as assessed normatively by the IOTN, was significantly associated with lower scores of "self-confidence" and higher scores of "social impact", "psychological impact" and "aesthetic concerns". Overall, the French version of the PIDAQ was shown to be reliable and has some validity for use in this population. Further studies including a larger sample size is recommended to reassess the validation and the responsiveness of this French version.

[Children who received a radiotherapy treatment of the cranio-cervico-facial region: appraisal of the orthodontic treatment need]

INTRODUCTION

Currently, 1 out of 900 adults from the ages of 16 to 44 is a survivor of childhood cancer. The global rate of survival for all types of childhood cancer is close to 80% and progress in treatment and care continues to offer promising results. In the years following treatment, these children, just like other healthy children, should have access to orthodontic care in spite of their chronic health problems.

OBJECTIVES

A transverse epidemiological study was conducted at the Leon Bernard Cancer Treatment Center in Lyon in order to respond to these requests and to assist orthodontists with the therapeutic difficulties presented by these patients. Our objective was to identify the orthodontic treatment required for children 7 years old or older who received antineoplastic therapy with radiation of the cranio-cervico-facial region.

RESULTS

The results show that children who received radiation therapy in the cranio-facial region presented delayed growth, facial asymmetry in 74% of the cases, overbite and overjet increased respectively in 70% and 61% of the cases. Dental discrepancies in development were present in 83% of the patients who presented with stunted teeth, premature closing of the apices and hypoplasias. We found sialopathy such as reduced saliva flow rate. Finally, considerable treatment was necessary in 61% of the cases and moderate treatment for 17% of the cases, because of missing teeth, retained deciduous teeth or an increased overjet.