A scanning electron microscopy investigation of the precision of three orthodontic bracket slot systems

OBJECTIVE

One of the most imprortant factors in achieving ideal teeth positions is the precision of the slot dimensions of orthodontic brackets into the archwires are inserted.This study aimed to assess the accuracy of the dimensions of orthodontic bracket slots and molar buccal tube apertures and to compare them with the specifications provided by the manufacturers.

METHOD

A total of sixty brackets and ten molar buccal tubes with varying slot heights were examined using a scanning electron microscope from the mesial side. The dimensions and morphology of these bracket slots and buccal tubes apertures were assessed using the AutoCAD Software. A one-sample t-test was conducted to compare the measurements with the values provided by the manufacturer.

RESULTS

The findings of the present study indicated that the height of the measured bracket slots and buccal tube apertures dimensions were significantly larger than the actual dimensions and exhibiting divergent walls. On the other hand, the depth of the brackets slots showed significantly smaller values than the actual one.

CONCLUSION

A need for careful consideration when selecting a commercially accessible brand for everyday use is essential as certain materials may not meet acceptable standards.

Effectiveness of tubular coaxial nickel-titanium and copper nickel-titanium orthodontic aligning archwires: A randomized clinical trial

BACKGROUND

This study aimed to compare tubular coaxial-NiTi and copper-NiTi orthodontic aligning archwires in terms of teeth alignment, patients' pain perception, and root resorption.

SUBJECTS AND METHODS

Orthodontic patients aged 12 years or older, having Little's irregularity index (LII) of 5-9mm were randomly allocated to either the copper-NiTi group or tubular coaxial-NiTi group with a 1:1 allocation ratio. The archwire sequence was 0.014-inch followed by 0.018-inch for the copper-NiTi group and 0.016-inch followed by 0.018-inch for the tubular coaxial-NiTi group. Each archwire was left in place for eight weeks before progressing to the next size. Good quality impression for the lower arch before treatment (T0) and thereafter every 4 weeks up to 16 weeks was taken to measure LII. Evaluation of pain perception was performed using a visual analog scale (VAS) during the first week following each archwire insertion. Assessment of root resorption was undertaken at T0 and after 16 weeks by taking periapical radiographs for mandibular central incisors using the long cone paralleling technique.

RESULTS

A total of 33 patients were randomized and selected for participation. Of those, 31 patients with a mean age of 15.45±2.22 who completed the trial were included in the analyses (15 patients in the copper-NiTi group and 16 patients in the tubular coaxial-NiTi group). In both groups, the irregularity index significantly decreased after 16 weeks of treatment with an overall reduction of 5.22mm for the copper-NiTi group and 6.03mm for the tubular coaxial-NiTi group. However, the difference between the two groups was not statistically significant. Likewise, pain perception and root resorption were not significantly different between the two study groups.

CONCLUSIONS

Both copper-NiTi and tubular coaxial-NiTi archwires were equally effective in terms of teeth alignment, patients' pain perception, and root resorption. Consideration could be given to the cost and clinician preference when selecting an initial archwire.

REGISTRATION

the trial was registered in ClinicalTrials.gov on 26/05/2022 with a registration ID: NCT05391542, https://clinicaltrials.gov/ct2/show/NCT05391542.

Evaluation of failure rate of molar tubes with a modified bonding technique: a randomized clinical trial

BACKGROUND

During orthodontic therapy, bond failure of molar tubes may delay treatment. With the high failure rate of molar tubes, alternative bonding techniques were tested to improve bond strength.

OBJECTIVES

To compare the failure rates of molar tubes bonded with conventional and alternative bonding techniques by adding a layer of compomer adhesive at the molar/tube interface.

TRIAL DESIGN

Single-centre, single-blinded, split-mouth, randomized clinical trial.

METHODS

Patients aged 12 years or older, who required fixed appliance orthodontic treatment without extraction and with no occlusal interference were eligible to participate. They were allocated randomly using a simple non-stratified split-mouth design with a 1:1 allocation ratio. Blinding was only possible for the patients and data analysts. Molar tubes bonded with the modified bonding technique had an additional layer of compomer at the occlusal molar/tube interface. The patients were followed-up for nine months. Outcome measures included the survival time of molar tubes and the number of molar tubes debonded. The bond failure of molar tubes was analyzed using Kaplan-Meier and Cox regression analysis (P < 0.05).

RESULTS

Thirty patients were recruited, randomized, and analyzed (mean age 20.33 years). The failure rate of molar tubes bonded with the modified bonding technique was 4.2 per cent and that of molar tubes bonded with the conventional bonding technique was 6.7 per cent. This difference was not statistically significant (P > 0.05). The dental arch and molar type were found to be as significant predictors for molar tube failure rate. No harm was detected during treatment.

LIMITATIONS

The effect of compomer to reduce enamel demineralization was not tested.

CONCLUSIONS AND IMPLICATIONS

The modified bonding technique did not significantly reduce the failure rate of molar tubes. The molar tubes bonded on the upper arch and second molars are more susceptible to debond.

REGISTRATION

The trial was registered with ClinicalTrials.gov on 21 May 2022 (Registration number: NCT05391386).

FUNDING

This research did not receive any funding.

Evaluating orthodontic bracket slot dimensions and morphology: A narrative review

The current article aims to review the previous studies that measure the orthodontic bracket slot dimensions and geometry. Searches in different databases, including PubMed Central, Science Direct, Wiley Online Library, the Cochrane Library, Textbooks, Google Scholar, and Research Gate, in addition to a manual search, were performed about the methods of assessing orthodontic bracket slot dimension up to March 2023. The irrelevant and duplicate studies were eliminated, leaving 35 studies for this narrative review. The findings indicate that the slots are oversized with diverging walls in most studies. Manufacturers must respect the standards during manufacturing brackets and adhere to the actual dimensions and tolerance values.

Methods of measuring distal canine movement and rotation- A review

This article provides an overview of the various methods for measuring distal canine movement and rotation during retraction. Various databases, including PubMed Central, Science Direct, Wiley Online Library, the Cochrane Library, Textbooks, Google Scholar, and Research Gate, and a manual search up until September 2022, were used to search for various methods of measuring distal canine movement and rotation during retraction. After excluding the duplicate articles, the papers explaining these techniques were included. Four significant techniques were identified. The digital method with 3D superimposition is the safest, most accurate, and most accessible of the methods reviewed.

Different Methods of Canine Retraction- Part 1

Background: This review aimed at explaining different methods of canine retraction along the archwire. Methods: Searching for different methods of canine retraction using fixed orthodontic appliances was carried out using different databases, including PubMed Central, Science Direct, Wiley Online Library, the Cochrane Library, Textbooks, Google Scholar, Research Gate, and hand searching from 1930 till February 2022. Results: After excluding the duplicate articles, papers describing the methods of canine retraction along the archwires were included. The most commonly used methods are NiTi closed coil spring and elastic chain. Conclusions: Various methods of canine retraction along the archwires were explained in detail regarding their advantages, disadvantages, and comparisons among different methods supported by clinical trials, systematic review, and meta-analysis. The preferred method is canine retraction with NiTi closed coil spring with 150 and 200 gm. Elastic chain is considered an alternative, low-cost option.

Effect of calcium fluoride nanoparticles in prevention of demineralization during orthodontic fixed appliance treatment: a randomized clinical trial

BACKGROUND

White spot lesions (WSLs) are the most common complications of fixed appliance orthodontic treatment.

OBJECTIVES

To evaluate the effectiveness of calcium fluoride nanoparticles-containing orthodontic primer (nCaF2-primer) in preventing the incidence of WSLs during orthodontic treatment.

TRIAL DESIGN

Single-centre, double-blinded, split-mouth, randomized clinical trial.

METHODS

The sample involved 31 orthodontic patients (≥12 years). Participants were recruited using a simple nonstratified randomization. Data collection, measurements, and analysis were performed blindly. Outcome measures included comparing the effect of nCaF2-primer with control primer (Transbond) regarding the degree of demineralization (DIAGNOdent pen), Streptococcus mutans (S. mutans) bacterial counting [real-time polymerase chain reaction device (PCR)], and WSLs incidence (pre- and post-operative photographs). The measurements were performed before bonding, 1, 3, and 6 months after bonding and after appliance removal. A two-way repeated measure analysis of variance test (for DIAGNOdent pen scores), and Wilcoxon signed-rank test (for the difference between bacterial counting and WSLs incidence) were used (P < 0.05).

RESULTS

Thirty-one patients were recruited and randomized (mean age 17.9 ± 2.45 years). For the primary outcome (DIAGNOdent pen scores) and secondary outcome of S. mutans counting: 31 patients (310 teeth for each group) were included in scoring at T1 and T3, and 30 patients (300 teeth) were included at T6. While for the photographic scores, 26 patients were included after bracket bonding. The demineralization scores showed significant differences at all-time intervals within the 6 months after bracket bonding which was more noticeable after the first month. There was a significant difference in bacterial count between the two primer groups at the T1 only. Regarding photographic scores, there were no significant differences in the WSLs incidence between the two primers groups after brackets removal. No harm was detected during treatment, except the usual pain/gingival irritation.

CONCLUSIONS

nCaF2-primer effectively decreased demineralization scores within the 6 months after bracket bonding. Moreover, it significantly reduced S. mutans colonization after the first month. However, the tested primer did not have an extra advantage in preventing WSLs development at the clinical level after appliance removal.

TRIAL REGISTRATION

The trial was registered with ClinicalTrials.gov on 8 May 2021 (registration number: NCT04994314).

Which anchorage device is the best during retraction of anterior teeth? An overview of systematic reviews

Objective

To evaluate the available evidence regarding the clinical effectiveness of different types of anchorage devices.

Methods

A comprehensive literature search of different electronic databases was conducted for systematic reviews investigating different anchorage methods published up to April 15, 2021. Any ongoing systematic reviews were searched using PROSPERO, and a grey literature search was undertaken using Google Scholar and OpenGrey. No language restriction was applied. Screening, quality assessment, and data extraction were performed independently by two authors. Information was categorized and narratively synthesized for the key findings from moderate- and high-quality reviews.

Results

Fourteen systematic reviews were included (11 were of moderate/high quality). Skeletal anchorage with miniscrews was associated with less anchorage loss (and sometimes with anchorage gain). Similarly, skeletal anchorage was more effective in retracting anterior teeth and intruding incisors and molars, resulting in minor vertical skeletal changes and improvements in the soft tissue profile. However, insufficient evidence was obtained for the preference of any anchorage method in terms of the duration of treatment, number of appointments, quality of treatment, patient perception, or adverse effects. The effectiveness of skeletal anchorage can be enhanced when directly loaded, used in the mandible rather than the maxilla, used buccally rather than palatally, using dual rather than single miniscrews, used for en-masse retraction, and in adults.

Conclusions

The level of evidence regarding anchorage effectiveness is moderate. Nevertheless, compared to conventional anchorage, skeletal anchorage can be used with more anchorage preservation. Further high-quality randomized clinical trials are required to confirm these findings.

The accuracy and reliability of WebCeph for cephalometric analysis

Objective

This study compares the accuracy and reliability of WebCeph (web-based program for cephalometric analysis) with the AutoCAD computer software.

Materials and methods

A sample of pretreatment digital lateral cephalograms of 50 orthodontic patients was analysed with WebCeph and AutoCAD software (as a standard measure). On each cephalogram, 17 landmarks and 11 measurements were marked and performed as skeletal, dental, and soft–tissue parameters. We used six angular and five linear measurements. A paired t-test was used to assess the systematic bias. The intraclass correlation coefficient (ICC) and Bland–Altman plot with linear regression analysis were used to assess the agreement between the two methods.

Results

There was adequate reproducibility for the measurements with both WebCeph and AutoCAD. The paired t-test showed statistically significant differences for five angular and two linear measurements (P < 0.05). The ICC test between WebCeph and AutoCAD revealed very good to excellent agreement for all measurements, except for the lower incisor to mandibular plane angle. The Bland–Altman plot visually showed a relatively acceptable limit of agreement for three angular and two linear measurements only, and the linear regression analysis revealed a significant proportional bias between the two methods for four angles and the upper lip-Esthetic line (U Lip-E Line). The systematic bias and level of agreement improved with the use of the semi-automatic WebCeph.

Conclusions

Different problems, such as poor landmark identification/soft tissue tracing and inconsistency of measurements, are inherent to the automatic WebCeph. The semi-automatic WebCeph can overcome some limitations of the automatic WebCeph; however, it should be used for cephalometric analysis with a great deal of caution.

Development of patient information leaflets for fixed, removable, and functional appliances for Arabic-speaking orthodontic patients

OBJECTIVE

To develop Orthodontic Patient Information Leaflets (PILs) in Arabic.

MATERIAL & METHOD

This study included five phases starting with Arabic translation of existing British Orthodontic Society leaflets; initial face validation with three orthodontists; content validation with ten orthodontists; final face validation with ten orthodontists, five postgraduate students, and ten patients; and re-translation to English prior to comparing the new documents with the original PILs to verify that all the necessary information were included. The content validity index (CVI) assessed item level (I-CVI) and scale level (S-CVI).

RESULTS

The three Arabic PILs were face validated with inclusion of mini-screws, rapid maxillary expansion, and interproximal reduction. Content validity was perfect with no item I-CVI < 0.80. The S-CVI/Ave for PIL Fixed Appliances = 0.98, PIL Removable Appliances = 0.98 and PIL Functional Appliances = 0.97. In the final face validation, the three leaflets received 100% agreement from all observers for consistency of leaflet format and style, clarity, readability and use of adequate phrases. Finally, the leaflets were re-translated and the information was checked by native English speakers to ensure the completeness of information. There were no discrepancies and face validity was excellent.

CONCLUSION

Valid PILs for Arabic-speaking patients undergoing orthodontic treatment with fixed, removable, and functional appliances have been developed.

A clinical comparison of the effectiveness of two types of orthodontic aligning archwire materials: a multicentre randomized clinical trial

OBJECTIVES

To compare the heat-activated nickel titanium (HANT) with superelastic nickel-titanium (SENT) archwires in terms of their effectiveness of aligning teeth, possibility of inducing root resorption, and perception of pain.

SUBJECTS AND METHODS

Orthodontic patients aged 12 years or over with mandibular anterior crowding of 3-6 mm, who required treatment without extractions were randomly allocated (a simple non-stratified randomization) to the HANT and SENT archwires groups with a 1:1 allocation ratio. The archwire sequence in both groups was 0.014-inch and 0.016-inch, respectively. Each archwire was placed for 4 weeks. The outcome measures included the amount of crowding assessed blindly using Little's irregularity index (LII), apical root resorption, and pain perception. The effectiveness of alignment was tested using 2 × 2 mixed factorial analysis of variance (ANOVA) model, while root resorption and pain perception were tested by the Mann-Whitney U-test and Wilcoxon signed-rank test (P < 0.05).

RESULTS

Thirty-four patients were randomized and recruited from four centres, of those 31 were analysed (15 participants for the HANT and 16 for the SENT groups) with an overall mean age of 19.13 ± 5.73 years. The total reduction in the LII was 2.69 mm and 2.74 mm for the HANT and SENT groups, respectively. This did not reach the level of statistical (P = 0.809) or clinical significance. Similarly, root resorption and pain perception showed non-significant difference between groups. However, there was a slight increase in root resorption with the SENT group.

LIMITATIONS

A long-term evaluation of root resorption is required.

CONCLUSIONS

Both HANT and SENT archwires were equally effective in the aligning stage of orthodontic treatment. Root resorption with SENT wires should be monitored throughout treatment.

REGISTRATION

The trial was registered with ClinicalTrials.gov on 18 September 2019, registration number: NCT04090931.

Orthodontic treatment and root resorption: an overview of systematic reviews

BACKGROUND

Root resorption can be considered the most unfortunate complication of orthodontic treatment.

OBJECTIVE

To evaluate the available evidence regarding orthodontically induced inflammatory root resorption (OIIRR).

SEARCH METHODS

A comprehensive literature search was conducted for the systematic reviews investigating OIIRR published up to 24 May 2020. This was accomplished using electronic databases: MEDLINE via OVID, EMBASE, AMED (Allied and Complementary Medicine Database), PubMed, and Web of Science. Any ongoing systematic reviews were searched using Prospero and a grey literature search was undertaken using Google Scholar and OpenGrey (www.opengrey.eu/). No language restriction was applied.

SELECTION CRITERIA

Only studies investigating OIIRR were included.

DATA COLLECTION AND ANALYSIS

Screening, quality assessment [using the AMSTAR 2 tool (A Measurement Tool to Assess Systematic Reviews)], and data extraction were performed by two authors independently. Information was categorized and narratively synthesized for the key findings from moderate and high-quality reviews.

RESULTS

A total of 2033 potentially eligible studies were identified. After excluding the non-relevant studies, 28 systematic reviews were included. Of which, 20 systematic reviews (71.5%) were of moderate and high-quality level of evidence. The incidence and severity of OIIRR increase with the fixed appliance, especially with heavy force, intrusion, torqueing movements, increased treatment duration, and treatment with extractions or with long apical displacement (particularly for maxillary incisors). There was insufficient evidence regarding most other treatment- and patient-related factors on OIIRR. Following all precautionary measures, pausing treatment and regular monitoring benefits patients with OIIRR.

CONCLUSIONS AND IMPLICATIONS

There is a limited number of high-quality studies in terms of OIIRR. The influence of fixed appliance on root resorption was noted; however, the cause and effect relationship between OIIRR and orthodontic biomechanics has not been confirmed. Avoiding heavy, continuous forces and a greater amount of apical displacement over a long duration of treatment is recommended. Precautionary measures should be carefully considered when treating patients with a high risk of OIIRR.

REGISTRATION

CRD42020166629.

The impact of labial fixed appliance orthodontic treatment on patient expectation, experience, and satisfaction: an overview of systematic reviews

Background

Patient perception with fixed appliance orthodontic treatment is important to improve oral health-related quality of life.

Objective

The main objective of this study was to evaluate the impact of labial fixed appliance orthodontic care on patient perception before, during, and after the treatment.

Search methods

Relevant systematic reviews investigating patient perception with fixed appliance orthodontic treatment were identified by searching electronic databases: MEDLINE via OVID (1946 to 31 December 2018), EMBASE (1974 to 31 December 2018), AMED (Allied and Complementary Medicine Database; 1985 to November 2018), PubMed (inception to 31 December 2018), Web of Science (1900 to 2018), and PsychINFO (1806 to 31 December 2018). Ongoing systematic reviews were searched using Prospero and a grey literature search was undertaken using Google Scholar and OpenGrey (www.opengrey.eu/). No language restriction was applied.

Selection criteria

Only studies investigating patient perception of fixed appliance orthodontic treatment were included.

Data collection and analysis

Screening, quality assessment [using the AMSTAR 2 tool (A Measurement Tool to Assess Systematic Reviews)], and data extraction were performed by two authors independently. Information was categorized and narratively synthesized for the key findings.

Results

A total of 163 articles investigating patient expectation, experience, and satisfaction with conventional ligation labial fixed orthodontic appliances were obtained. Of these, 152 observational or interventional studies were excluded, resulting in 11 eligible systematic reviews. Two were excluded as earlier reports of a Cochrane review. The quality of the reviews was variable (critically low, low, and moderate). The findings were as follows: aesthetics represents a primary motive for orthodontic treatment; a temporary deterioration in the quality of life occurs during the initial phases of treatment; gender and ethnicity factors do not have an impact on patient perception of treatment; and a positive relationship between orthodontist–patient–parent is important to achieve patient compliance and satisfaction.

Conclusions

There is a lack of high-quality studies in terms of systematic reviews and meta-analyses for assessing patient perception with fixed appliance orthodontic treatment. The aesthetic impact of malocclusion is the main motive for seeking orthodontic treatment. Quality of life reduces during the initial stages of orthodontic treatment but improves in the later stages of treatment. Assessment before, during, and after orthodontic treatment is necessary to comprehensively assess patient perception at all stages of care.

Trial registration

CRD42019122653.

Conflict of Interest

None to declare.

Does anchorage loss differ with 0.018-inch and 0.022-inch slot bracket systems?

OBJECTIVES

To compare maxillary first molar anchorage loss between 0.018-inch and 0.022-inch slot fixed appliance systems.

MATERIALS AND METHODS

Patients requiring bilateral maxillary premolar extractions (n = 74) within a randomized clinical trial comparing the effectiveness of 0.018-inch and 0.022-inch slot MBT bracket systems (3M-Unitek, Monrovia, Calif) were included. Three-dimensional pre- and posttreatment digital models were landmarked and measured (R700 scanner and OrthoAnalyzer software, 3Shape, Copenhagen, Denmark). Anteroposterior position of the first molars was measured using the third medial rugae point as a reference. Anchorage loss (AL) represented the subtraction of the posttreatment distance from the pretreatment distance for both anchorage loss right (ALR) and left (ALL) sides. The values were then compared using a two-way analysis of variance.

RESULTS

There were 41 and 33 cases for the 0.018-inch and 0.022-inch bracket slot systems, respectively. The baseline characteristics were similar between groups, except for the presence or absence of anchorage devices (P = .050). For the total sample: 0.018-inch ALR = 3.86 mm, ALL = 3.30 mm and 0.022-inch ALR = 3.73 mm, ALL = 3.47 mm (P = .970). There was also no significant difference between the 0.018-inch and 0.022-inch groups when subjects with anchorage devices were excluded (P = .383).

CONCLUSIONS

Bracket slot size does not influence maxillary molar anchorage loss during orthodontic treatment.

A randomized clinical trial of the effectiveness of 0.018-inch and 0.022-inch slot orthodontic bracket systems: part 3-biological side-effects of treatment

OBJECTIVE

To compare orthodontically induced inflammatory root resorption (OIIRR) and patient perception of pain during orthodontic treatment between 0.018-inch and 0.022-inch slot bracket systems.

SUBJECTS AND METHODS

Eligible participants aged 12 years or above were allocated to treatment with the 0.018-inch or 0.022-inch slot MBT appliance (3M Unitek, Monrovia, California, USA) using block randomization in groups of 10. OIIRR was assessed radiographically using standardized periapical radiographs before and after 9 months from the start of treatment. Patient perception of pain was assessed using a validated patient questionnaire at 6 months from the start of treatment. Parametric tests (t-test) and non-parametric tests (chi-square with Fisher's exact tests and Kruskal-Wallis test) assessed differences between the groups (P < 0.05). The correlation between severity of OIIRR and abnormal root morphology, history of dental trauma, and pain during treatment was assessed.

RESULTS

Of the 187 participants randomized (1:1 ratio), 34 withdrew or were excluded (protocol deviations or poor cooperation). There were 77 patients in the 0.018-inch slot group and 76 patients in the 0.022-inch slot group (overall mean age: 19.1 years). Baseline characteristics were similar between groups (P > 0.05). There was no significant difference in the severity of the OIIRR nor patient perception of pain between the two study groups (P = 0.115 and P = 0.08 respectively). The correlation between the severity of OIIRR and abnormal root morphology or history of dental trauma was not statistically significant (P = 0.086 and P = 0.313). Moreover, there was no significant correlation between the severity of OIIRR and pain during treatment (R = 0.045, P = 0.617).

LIMITATIONS

It was impossible to blind clinicians or patients to allocation, and oral hygiene and periodontal outcomes were not assessed.

CONCLUSIONS

The effect of bracket slot size on the severity of OIIRR and patient perception of pain are not significant.

TRIAL REGISTRATION

The trial was registered with ClinicalTrials.gov on 5 March 2014, registration number: NCT02080338.

A randomized clinical trial of the effectiveness of 0.018-inch and 0.022-inch slot orthodontic bracket systems: part 2-quality of treatment

OBJECTIVE

To compare the quality of orthodontic treatment between 0.018-inch and 0.022-inch slot bracket systems.

SUBJECTS AND METHODS

Eligible participants aged 12 years or over were allocated to the 0.018-inch or 0.022-inch slot MBT appliance (3M-Unitek, Monrovia, California, USA) using block randomization in groups of 10. Outcome measures included: 1. ABO cast-radiograph evaluation (CR-EVAL), 2. peer assessment rating (PAR) scores, 3. incisor inclination, and 4. patient perception using the Index of Orthodontic Treatment Need aesthetic component (IOTN AC) and three validated questionnaires before, during and after treatment. Parametric tests [independent samples t-test and two-way analysis of variance (ANOVA)] and non-parametric tests (chi-square with Fisher's exact tests and Mann-Whitney U-test) assessed differences between groups (P < 0.05).

RESULTS

Of the 187 participants randomized (1:1 ratio), 34 withdrew or were excluded (protocol deviations or poor cooperation). There were 77 patients in the 0.018-inch slot group and 76 patients in the 0.022-inch slot group (overall mean age: 19.1 years). Baseline characteristics were similar between groups (P > 0.05). The mean total ABO CR-EVAL scores were 34.7 and 34.5; mean percentage PAR score reduction 74.1 per cent and 77.1 per cent; mean change for maxillary incisor inclination 2.9 degrees and 1.6 degrees and for mandibular incisor inclination 2.7 degrees and 1.4 degrees for the 0.018-inch and 0.022-inch groups, respectively. Improvement in patient perception of aesthetics after treatment was statistically significant for both groups (P < 0.05). However, there were no statistically significant differences between the two treatment groups for ABO CR-EVAL, percentage PAR score reduction, incisor inclination, and patient perception of treatment (P > 0.05). No adverse events were observed during treatment.

LIMITATIONS

It was impossible to blind clinicians or patients to allocation and oral hygiene and periodontal outcomes were not assessed.

CONCLUSIONS

There were no statistically or clinically significant differences in the quality of occlusal outcomes, incisor inclination and patient perception of treatment between 0.018-inch and 0.022-inch slot bracket systems.

REGISTRATION

The trial was registered with ClinicalTrials.gov on 5 March 2014, registration number: NCT02080338.

PROTOCOL

The protocol was published at DOI: 10.1186/1745-6215-15-389.

Three questionnaires to assess the perception of fixed orthodontic therapy before, during and after treatment: validity and reliability

Background/objective

To assess the validity and reliability of a series of three questionnaires for the quantification of patient perception of fixed appliance orthodontic treatment.

Subjects and methods

The study was carried out at the University of Dundee with content and face validity being assessed using proformas. Initially ten experts (Orthodontic Specialists) assessed content validity with 11 professionals (seven Orthodontic Specialists and four Postgraduates) and 20 patients assessing face validity. Content validity was determined according to the values of item-level content validity index (I-CVI) and scale-level CVI (S-CVI/Ave), while specially designed feedback forms were used for face validation. Internal consistency determined the reliability of the questionnaires according to the value of Cronbach alpha correlation coefficient test. The three questionnaires were then modified according to the recommendations of professionals and patients with seven experts reassessing content validity and ten newly selected patients assessing face validity.

Results

The first round of content validity revealed that around half of the items in the questionnaires were not valid. Therefore, the questionnaires were not valid as a whole (S-CVI/Ave = 0.60). After modifying the questionnaires and removing the non-valid items, the new versions of the Pre-treatment, Orthodontic Experience, and Post-treatment Questionnaires showed high levels of face validity, content validity (S-CVI/Ave: 0.99, 0.97, and 0.99, respectively) and good levels of internal consistency (α = 0.86, 0.78, and 0.88, respectively).

Limitation

The patient sample was collected from a single university clinic and from one city within the UK and this could affect the generalizability of the results.

Conclusion

Three content valid and reliable questionnaires have been developed and validated for the evaluation of patient perception of fixed appliance orthodontic treatment.

Implications

Unlike other tools that assess oral health-related quality of life, this series of three questionnaires assess the perception of fixed appliance orthodontic treatment before, during and after treatment.