Treatment strategies for lower third molars following orthodontic care

Expert panels as a reference standard in orthodontic research: An assessment of published methods and reporting

INTRODUCTION

The aim of this study was to investigate the expert panel methodology applied in orthodontics and its reporting quality. Additionally, the relationship between the reporting quality and a range of variables was explored.

METHODS

PubMed was searched for orthodontic studies in which the final diagnosis or assessment was made by 2 or more experts published up to March 16, 2015. Reporting quality assessment was conducted using an established modified checklist. The relationship between potential predictors and the total score was assessed using univariable linear regression.

RESULTS

We identified 237 studies with a mean score of 9.97 (SD, 1.12) out of a maximum of 15. Critical information about panel methodology was missing in all studies. The panel composition differed substantially across studies, ranging from 2 to 646 panel members, with large variations in the expertise represented. Only 17 studies (7.2%) reported sample size calculations to justify the panel size. Panel members were partly blinded in 65 (27.4%) studies. Most studies failed to report which statistic was used to compute intrarater (65.8%) and interrater (66.2%) agreements. Journal type (nonorthodontic: β, 0.23; 95% CI, -0.07 to 0.54 compared with orthodontic), publication year (β, 0; 95% CI, -0.02 to 0.02 for each additional year), number of authors (1-3: β, 0.30; 95% CI, -0.13 to 0.74 compared with at least 6; 4-5: β, 0.18; 95% CI, -0.29 to 0.33 compared with at least 6), and number of centers involved (single: β, 0.20; 95% CI, -0.14 to 0.54 compared with multicenter) were not significant predictors of improved reporting. Studies published in Asia and Australia had significantly lower scores compared with those published in Europe (β, -0.54; 95% CI, -0.92 to -0.17).

CONCLUSIONS

Formal guidelines on methodology and reporting of studies involving expert panels are required.

Management of ectopic maxillary canines: variations among orthodontists

OBJECTIVE

To document and analyze factors involved in decision-making by orthodontists in managing disturbances of eruption of maxillary canines.

MATERIAL AND METHODS

The participants comprised orthodontic specialists and active members of the Swedish Orthodontic Society. Those selected for the study sample were under 65 years of age or younger and had been treating orthodontic patients for at least 1 year as a specialist. Three typical cases were presented for treatment proposals. The case notes, including radiographs and specific background data, were sent to the 182 selected orthodontists. The orthodontists were also requested to complete a questionnaire about practice profile, comprising eight questions.

RESULTS

The response rate was 86.3%; yielding 157 participants (mean age 53.8 years, SD 8.12). Analysis disclosed no differences between responders and nonresponders regarding age, gender, and years of specialist practice. For treatment plans based on panoramic radiographs, intraoral radiographs, and status and anamnesis, there was general consensus. However, when supplementary information from computer tomography (CT) was provided, disclosing root resorption half-way to the pulp or more on the lateral incisor, the orthodontists' treatment proposals varied. Gender, age, and practice profile of the orthodontists had little association with the decision-making.

CONCLUSIONS

Supplementary CT information led to variations in decision-making with respect to treatment of eruption disturbances of maxillary canines. This lack of consensus among specialist orthodontists can have negative implications for patients.

Third molar management: a case against routine removal in adolescent and young adult orthodontic patients

In the nearly two decades since the National Institutes of Health conference, controversy and uncertainty have continued with respect to the diagnosis and treatment of impacted, nondiseased third molars in adolescents and young adults. Articles published over the past 10 years have studied the issue from the vantage point of risk management. Those who favor prophylactic removal justify this action on three premises: 1. All impacted third molars are potentially pathologic; therefore, prophylactic removal reduces or eliminates risk of future disease. 2. The presence of third molars can cause late crowding. 3. Removal during adolescence and young adulthood reduces risks of operative and postoperative complications compared with older patients. Those who favor conservative management offer three counter arguments: 1. Although impacted third molars do pose a risk of a pathologic condition, the risk is relatively small in comparison with the risks of operative and postoperative complications and the costs of unnecessary removal. 2. Although some investigators have shown a statistical association of third molars and late anterior crowding, the association is not strong enough to allow prediction of patients at risk. This is due principally to the high degree of individual variability, suggesting that many other factors interact in the development of postadolescent crowding. 3. Although studies have shown that morbidity is reduced when impacted, nondiseased third molars are removed during adolescence or young adulthood, the cost-risk-benefit data do not justify routine removal. Proponents of prophylactic removal argue that the benefits outweigh the risks. Proponents of conservative management argue that the scientific evidence is inconclusive in support of prophylactic removal. Unfortunately, much of the clinical research has been flawed. This has led to contradictory interpretations that have not fully clarified the relative risks and benefits of early intervention. Untrustworthy data have served only to fuel the debate and controversy concerning proper protocols. However, careful analyses of the published research show that routine removal of impacted or unerupted, disease-free third molars cannot be justified. A case-by-case management protocol that requires monitoring development represents the consensus of most researchers in this field.