Journal of Orthodontics

To evaluate whether patients who had received early class III protraction facemask treatment were less likely to need orthognathic surgery compared with untreated controls. This paper is a 6-year follow-up of a previous clinical trial.

Multi-centre 2-arm parallel randomized controlled trial.

Eight United Kingdom hospital orthodontic departments.

Seventy three 7- to 9–year-old children.

Patients were randomly allocated, stratified for gender, into an early class III protraction facemask group (PFG) (n = 35) and a control/no treatment group (CG) (n = 38). The primary outcome, need for orthognathic surgery was assessed by panel consensus. Secondary outcomes were changed in skeletal pattern, overjet, Peer Assessment Rating (PAR), self-esteem and the oral aesthetic impact of malocclusion. The data were compared between baseline (DC1) and 6-year follow-up (DC4). A per-protocol analysis was carried out with n = 32 in the CG and n = 33 in the PFG.

Thirty six percent of the PFG needed orthognathic surgery, compared with 66% of the CG (P = 0.027). The odds of needing surgery was 3.5 times more likely when protraction facemask treatment was not used (odds ratio = 3.34 95% CI 1.21–9.24). The PFG exhibited a clockwise rotation and the CG an anti-clockwise rotation in the maxilla (regression coefficient 8.24 (SE 0.75); 95% CI 6.73–9.75; P < 0.001) and the mandible (regression coefficient 6.72 (SE 0.73); 95% CI 5.27–8.18; P < 0.001). Sixty eight per cent of the PFG maintained a positive overjet at 6-year follow-up. There were no statistically significant differences between the PFG and CG for skeletal/occlusal improvement, self-esteem or oral aesthetic impact.

Early class III protraction facemask treatment reduces the need for orthognathic surgery. However, this effect cannot be explained by the maintenance of skeletal cephalometric change.

To compare the clinical performance of nickel titanium (NiTi) versus stainless steel (SS) springs during orthodontic space closure.

Two-centre parallel group randomized clinical trial.

Orthodontic Department University of Manchester Dental Hospital and Orthodontic Department Countess of Chester Hospital, United Kingdom.

Forty orthodontic patients requiring fixed appliance treatment were enrolled, each being randomly allocated into either NiTi (n = 19) or SS groups (n = 21). Study models were constructed at the start of the space closure phase (T₀) and following the completion of space closure (T₁). The rate of space closure achieved for each patient was calculated by taking an average measurement from the tip of the canine to the mesiobuccal groove on the first permanent molar of each quadrant.

The study was terminated early due to time constraints. Only 30 patients completed, 15 in each study group. There was no statistically significant difference between the amounts of space closed (mean difference 0.17 mm (95%CI −0.99 to 1.34; P = 0.76)). The mean rate of space closure for NiTi coil springs was 0.58 mm/4 weeks (SD 0.24) and 0.85 mm/4 weeks (SD 0.36) for the stainless steel springs. There was a statistically significant difference between the two groups (P = 0.024), in favour of the stainless steel springs, when the mean values per patient were compared.

Our study shows that stainless steel springs are clinically effective; these springs produce as much space closure as their more expensive rivals, the NiTi springs.

This study evaluated the quality, reliability and readability of information on the Internet on adult orthodontics.

A quality assessment of adult orthodontic websites.

Postgraduate Orthodontic Unit, Cork University Dental School and Hospital, Cork, Ireland.

An Internet search using three search engines (Google, Yahoo and Bing) was conducted using the terms (‘adult orthodontics’ and ‘adult braces’). The first 50 websites from each engine and under each search term were screened and exclusion criteria applied. Included websites were then assessed for quality using four methods: the HON seal, JAMA benchmarks, the DISCERN instrument and the LIDA tool. Readability of included websites was assessed using the Flesch Reading Ease Score (FRES).

Only 13 websites met the inclusion criteria. Most were of US origin (n = 8; 61%). The authors of the websites were dentists (n = 5; 39%), professional organizations (n = 2; 15%), past patients (n = 2; 15%) and unspecified (n = 4; 31%). Only 1 website displayed the HON seal and three websites contained all JAMA benchmarks. The mean overall score for DISCERN was 3.9/5 and the mean total LIDA score was 115/144. The average FRES score was 63.1/100.

The number of informative websites on adult orthodontics is low and these are of moderate quality. More accurate, high-quality Internet resources are required on adult orthodontics. Recommendations are made as to how this may be achieved.

To evaluate the total light energy (TLE) transmission through three types of ceramic brackets with, bracket alone and with the addition of orthodontic adhesive, at different exposure durations, and to compare the microhardness of the cured adhesive.

Three different makes of ceramic brackets, Pure Sapphire^M, Clarity™ ADVANCED^P and Dual Ceramic^P were used. Eighteen specimens of each make were prepared and allocated to three groups (n = 6). MARC^®-resin calibrator was used to determine the light curing unit (LCU) tip irradiance (mW/cm²) and TLE (J/cm²) transmitted through the ceramic brackets, and through ceramic bracket plus Transbond™ XT Light Cure Adhesive, for 5, 10 and 20 s. Vickers-hardness values at the bottom of the cured adhesive were determined. Statistical analysis used one-way analysis of variance (ANOVA); P = 0.05.

TLE transmission rose significantly among all samples with increasing exposure durations. TLE reaching the adhesive- enamel interface was less than 10 J/cm², and through monocrystalline and polycrystalline ceramic brackets was significantly different (P < 0.05). Pure Sapphire^M showed the highest amount of TLE transmission and Vickers-hardness values for 5, 10 and 20 s.

Following manufacturer's recommendations, insufficient TLE may be delivered to the adhesive: increasing the exposure durations may be required when adhesive is cured through ceramic brackets. Clinicians are advised to measure the tip irradiance of their LCUs and increase curing time beyond 5 s. Orthodontic clinicians should understand the type of light curing device and the orthodontic adhesive used in their practice.

Postgraduate orthodontic education is highly challenging. There is a lack of evidence regarding orthodontic postgraduates’ perceptions of their orthodontic education in the United Kingdom. In addition, no study has been conducted to compare the postgraduate orthodontic training experience between UK trainees and international postgraduates.

(1) To investigate orthodontic UK trainees’ and international postgraduates’ perception and satisfaction of their orthodontic education. (2) To compare postgraduate orthodontic training experience between UK trainees and international postgraduates. (3) To compare orthodontic caseload between UK trainees and international postgraduates.

Utilizing a descriptive, cross-sectional survey, conducted through a web-based self-administered questionnaire, the sample population consisted of all 189 orthodontic postgraduates in the United Kingdom.

One hundred and twenty-five questionnaires were completed resulting in a response rate of 66.1%. All three academic years were evenly represented. Ninety five (76%) respondents rated the quality of their postgraduate orthodontic education as excellent. Over 90% of third year postgraduates felt the quality of their education was excellent. The majority of orthodontic trainees (n = 98, 78.4%) were satisfied with the number of cases. Apart from the first year postgraduates, other postgraduates regardless of UK trainee or international postgraduate status reported a high number of cases in treatment, with 45 (36%) respondents treating more patients than the recommended range of 80–120. Postgraduates’ responses were less positive regarding their ability to influence the delivery of their programme, whether their programme represented value for money and the fairness of their training. Most of the respondents believed that UK trainees had an advantage in communicating with patients.

The majority of orthodontic postgraduates rated the quality of their postgraduate education as excellent. Apart from first year postgraduates, other postgraduates irrespective of UK trainee or international postgraduate status reported a high number of cases in treatment. There was no difference in caseload between UK trainee and international postgraduate groups.